In this three-part article, I intend to make the case against the inclusion of drug prescriptive rights for doctors of chiropractic. Throughout this article, I will refer to this effort to take chiropractic down the path of prescriptive rights as the "drug initiative." I will also refer to the chiropractors that wish to promote this initiative as "pharma-practors."
The drug initiative issue was thrust into the forefront of conversation three years ago when the state of New Mexico passed a law allowing limited prescriptive rights to DCs. Not content with the limited formulary allowed in that act, the New Mexico DCs behind the prescriptive rights movement decided to go all the way by attempting to pass a law allowing DCs the right to prescribe virtually the entire prescription formulary of the United States. Thankfully, this law did not pass, but they are still trying.
Fast-forward to today, when our profession should be focused on how the new Patient Protection and Affordable Care Act (PPACA or "Obamacare") impacts our profession, and how we can work together to assure full chiropractic inclusion for all of the people who will now be covered by some kind of health care insurance. Instead, we find ourselves once again divided on the issue of scope of practice and in particular, the drug initiative.
I'll attempt to articulate and refute the arguments for drugs in chiropractic, as well as to state the arguments against drugs in chiropractic. My hope is to raise awareness of this issue – and its implications – so the profession will engage in whatever debates are necessary to come to a positive resolution of it.
How We Got Licensed in the First Place
I'd like to begin by reminding the profession that the reason chiropractic got licensed in the first place was that in every state (and in other countries as well), the chiropractors had to demonstrate that they weren't practicing medicine without a license. To accomplish this, they had to prove they were practicing something altogether new, unique, separate, distinct and practiced according to a principle that the medical profession either ignored or refused to accept altogether.
That principle, of course, was that a human being has an "innate intelligence." Because of this intelligence human beings are conscious, self-developing, self-maintaining and self-healing organisms. The principle further held that this intelligence, if interfered-with in any manner, would result in a lack of life, impaired health and a state of "dis-ease."
The practice of chiropractic was the discipline of detecting and correcting the causes of the interference (subluxations, thoughts, toxins, traumas, etc.). When these causes were corrected, and the innate intelligence was allowed to express completely, the body would return to homeostasis (heal) and maintain a state of health and well-being. This was clearly not the practice of medicine. But it was the definition of chiropractic that got us licensed.
Despite the best efforts by the medical profession to make sure the chiropractors were neither granted licensure, nor allowed to practice chiropractic (another story altogether), the profession ultimately made the case in all 50 legislatures in the United States. Those pioneer chiropractors proved that their profession was indeed a separate and distinct healing discipline and in no way duplicated allopathic medicine. Licensing of our profession was granted based upon this fact.
Historically, more than 15,000 chiropractors were prosecuted for practicing medicine without a license, and over 12,000 of them were actually jailed for doing so! Yet, the pharma-practors insist on disrespecting this history, the sacrifices that were made by our courageous forebears, our hard-won licensing, and the real reasons we gained our licenses, in order to move their agenda forward.
When I decided to become a doctor of chiropractic, the profession was drug-free and the very antithesis of drugs – and still is. It was the same way for the pharma-practors promoting the drug initiative. They didn't choose chiropractic so they could prescribe drugs; no one ever did! Yet today, they are attempting to unalterably change the chiropractic profession so they can. They're trying to change the bargain, practicing a drug-free chiropractic profession, without the permission of their fellow DCs, and what they are doing is profoundly unethical.
The pharma-practors must know that the drug initiative would fundamentally change chiropractic into just another allopathic profession. They must also know that a license to prescribe drugs cannot co-exist with a traditional chiropractic license. History proves it.
The only conclusion I can come to is that the ultimate goal of the pharma-practors is to achieve an unlimited, allopathic scope of practice and to ultimately destroy chiropractic as we know it today.
The Moral Argument for Drugs in Chiropractic
There is no debate that certain drugs, when judiciously prescribed and not abused, are beneficial to the health and well-being of mankind. Antibiotics have certainly been beneficial in treating infectious diseases; certain pain-relieving drugs, when used properly, have certainly made life more tolerable for many; and anesthetic drugs have made surgery possible. There are no doubt hundreds of drugs and medications that have saved lives and helped to relieve human suffering.
That said, a moral argument in favor of chiropractors prescribing drugs would suggest that some additional benefit would inure to mankind if doctors of chiropractic could prescribe them.
However, particularly in the United States, approximately 50 percent of the citizens are already taking some prescription medication. If such market penetration by the pharmaceutical industry were enhancing the health and well-being of the people taking these drugs, then this argument might be sound. However, the facts show quite the opposite.
By virtually any measure, the U.S. is the sickest developed nation in the world. The abuse of prescription and other medications are a primary reason for this. To argue that the world in general, and the United States in particular, needs another health care professional with prescriptive rights is simply ludicrous in the extreme. There is no credible moral argument that supports the idea that the world needs yet another profession to add to its ability to obtain prescription drugs.
The "To Be a Primary Care Physician, You Must Prescribe" Argument
This argument is probably the most compelling argument that can be made if we as a profession agreed upon the definition of the term primary care physician (PCP). But we don't.
Some factions of the profession believe that DCs either are – or should be – primary care physicians in the same sense as MDs or DOs. In other words, they should be able to accept any patient, with any conditions, without referral, and treat them.
Other factions maintain the position that we are already primary care physicians for all practical purposes due to the fact that we are "primary contact" physicians and require no referral from other providers. The problem with this definition is that most legal and regulatory definitions of primary care physician describe a physician who is not limited in scope as most doctors of chiropractic are by their state law.
The contradictory views of what constitutes a "primary care physician" lie at the heart of this debate. Those who believe that PCPs are – or should be – physicians who can treat anything and everything, are often philosophically sympathetic to the drug initiative.
But historically, chiropractic has never fit the legal and regulatory definition of primary care physician. Chiropractors, in the vast majority of jurisdictions, have always been legally limited, yet have practiced in a primary contact mode.
So, as doctors of chiropractic, do we need the label "primary care physician" in order to be of maximum benefit to mankind? In my view, we don't. Doctors of chiropractic are already trained quite well enough to function as PCPs. In either definition of PCP, prescribing drugs is unnecessary. The role of the PCP is to see patients, determine the nature and cause of their problems, and then either accept them as patients or refer them to the appropriate provider. This is no different from the MD or DO's role as primary care provider.
The "Shouldn't DCs Help Reduce the 'Severe Shortage' of Primary Care Physicians?" Argument
Granted, there are areas of the country where primary care physicians of any kind are in short supply, but very few. While this argument has some appeal, it too fails to pass the "smell test." For the people in such areas I would say that you are lucky indeed that you live in such a remote area as to have limited access to medical care. You'll probably live a longer, healthier life as a result.
This argument ignores the fact that doctors of chiropractic are already primary care providers in the practical definition of that term. If patients knew the extent of the training and ability of the doctor of chiropractic with their current scope of practice, they would know that a visit to the chiropractor would be appropriate in a great number and variety of situations. But that's the problem: Patients don't know what we know / do, and we've done a poor job of educating them.
Add to this the fact that the AMA has been actively opposing, containing and trying to eliminate everything we do for the past 100 years or longer, and you have the condition we find ourselves in as a profession. That is, we have a movement, the drug initiative, whose solution is to become a me-too, third-rate (behind medicine and osteopathy), duplicative, allopathic profession. This is another false argument presented in the form of a solution to a problem that doesn't really exist.
The "Our Patients Need Drugs Until We Can Get Them Out of Pain" Argument
I've been in practice since 1980. Every single patient who's come into my office in pain also has no shortage of drugs. They get the drugs from their medical doctor, the drug store, their bathroom cabinet, and who knows where else. The point is, there never has been, there is not currently, and there never will be a shortage of drugs – or people to supply them. This argument is disingenuous at best.
The "You Can't Take Them Off Drugs If You Can't Prescribe Them" Argument
This argument is an insult to the intelligence of those they're trying to fool with it. There are two problems with this argument. First, you don't need to take people off of drugs to enlighten them about the benefits of chiropractic care and making positive, healthy lifestyle choices. When people are educated, they will either discontinue their meds on their own, or in cooperation with their allopathic provider.
The second problem with this argument is that it is ridiculous to argue that a real reason to have prescriptive rights is to take people off their medications. I think we can all agree that if DCs were given the right to prescribe, they wouldn't use it primarily to take people off their medications.
The "States Have the Right to Define the Scope of Practice of Chiropractic" Argument
This is the so-called "states' rights" argument. Yes, states do have the right to do whatever they wish to do. But there are a lot of things they have the right to do, but don't do. States typically pass laws that legislatures and governors deem in the public interest. How giving DCs prescriptive rights is in the public interest is the argument the pharma-practors will have to make. Good luck with that.
As a practical matter, changing one state law will be an enormous challenge, let alone changing 50 state laws. The amount of money, political capital, grassroots political activity, not to mention chiropractic unity on the issue would all have to be raised to levels unprecedented in our history. This initiative will be devastating to the ability of the profession to move forward on any other issue, and at a time when professional unity is more needed than ever before.
Making legislative change of this nature is a long, difficult and in some cases, impossible process. In many places, it's proven to be just that, impossible. Despite chiropractic inroads in Europe and other areas of the world in the past 100 years, most of those countries still do not license and regulate chiropractic as it is, much less if they decided to compete with medicine and medical doctors. Imagine the lobbyist for the local "pharma-practic" association (PPA) trying to sell their local legislator on this idea. Good luck with that.
Part 2 of this article appears in the Sept. 1, 2013 issue and continues Dr. Klapp's evaluation of the arguments proposed for allowing prescribing privileges within the chiropractic profession. Part 3 (Sept. 15 issue) will address the arguments against drugs in chiropractic.
Dr. Thomas Klapp has extensive experience in national chiropractic politics, having served on the board of the International Chiropractors Association in the 1990s and early 2000s, and as president of the Congress of Chiropractic State Associations from 2000 to 2002, after serving on that board the 10 years prior. He has also been active in his home state of Michigan, serving in every executive office of the Michigan Chiropractic Association in the 1980s and spearheading the MCA's merger with the Michigan Chiropractic Society several years ago to form the Michigan Association of Chiropractors. Currently, Dr. Klapp chairs the Michigan Board of Chiropractic Examiners and is the Michigan delegate to the Federation of Chiropractic Licensing Boards and the National Board of Chiropractic Examiners. He has been in continuous practice in Ann Arbor, Mich., for the past 33 years.