Editor's note: This three-part article makes the case against the inclusion of drug prescriptive rights for doctors of chiropractic. Throughout this article, Dr. Klapp refers to this effort to take chiropractic down the path of prescriptive rights as the "drug initiative," while referring to the chiropractors who wish to promote this initiative as "pharma-practors."
The "'Tiering' of the Profession Allows Everyone to Practice How They Want" Argument
These pharma-practors are telling a lie. That lie is that two "tiers" of the profession, one with "advanced practice" chiropractors and another with traditional chiropractors, would allow everyone to practice how they want.
The problem with this lie, and the reason we know it's a lie, is that we already have experience with this. Throughout our history, those who wanted "broad scope" told those who didn't that if they could only have what they want, those who didn't want it could still practice in as limited a manner as they want. The trouble is it never turned out that way.
When the broad-scope practitioners get what they want, the CCE has to set standards for it, the schools have to teach it, the NBCE has to test for it, the states have to regulate it, and everyone else has to learn and eventually practice it ... whether they want to do it – or like it – or not.
So, exactly how broad a scope is too broad a scope for chiropractic? For the pharma-practors, apparently there is no such thing. It's clear that they will not be satisfied with the scope of practice until they have an allopathic, unlimited scope of practice. Of course, if that ever happened, chiropractic as we know it will disappear from the Earth – to the detriment of humankind.
The "We Need to Prescribe to Gain Moral Authority" Argument
This is an argument for those DCs who feel they deserve to be more successful, more respected and more accepted than they feel they are. Unfortunately for all of us, the lack of "moral authority" we as a profession so covet is the result of generations of medical bigotry, the AMA's long-standing and highly effective war on chiropractic, and their persistent behind-the-scenes poisoning of our water. Anyone who believes our lack of moral authority is due to the fact that we can't prescribe drugs is badly deluded.
What gives the medical doctor moral authority is the fact that they have achieved and maintain a monopoly in the health care marketplace. When the chiropractic profession attempts to break through and play on a level playing field, the medical propaganda machine fires up to assure that the "quacks, charlatans, and cultists" don't make any inroads to respectability.
Some say the mythical "level playing field" finally happened in 1992 with the AHCPR government report that spine surgery was the poorest choice for dealing with back pain and that spinal manipulation was the best. The spine surgeons, outraged at this direct invalidation of their practices, ramped-up their political machinery and got the AHCPR report discredited and the agency that created it, de-funded. Bye-bye level playing field. Now how's that for "moral authority?"
As for the science, it clearly shows chiropractic care hands-down is the best choice for patients with all kinds of conditions. Yet the medical profession, conspiring with the health insurance industry, the pharmaceutical industry and the government itself, maintains its steadfast opposition to the threat chiropractic poses to its monopoly.
We do pose a significant threat, of course. If the public was given full access to chiropractic benefits, the cost savings would create significant medical unemployment. Our enemies aren't about to let that happen without a fight.
The "We Need to Prescribe to Make More Money" Argument
There are so many things wrong with this argument that I'm not sure where to begin. But I'll start with the fact that I'm absolutely in favor of DCs making money – and lots of it. But I'm intensely opposed to the drug initiative, especially if its purpose is to allow the pharma-practors to make a few more bucks.
If this drug initiative is just a naked money grab, it is unethical, immoral and repugnant in the extreme. To add to the havoc that prescription drugs bring to humanity already, and to simultaneously destroy the only profession that has openly maintained a drug-free stance for 118 years just so these people can enrich themselves (they believe), is even more so.
Another serious problem with this argument is that there is a huge – and unfounded – assumption behind it: that by being able to prescribe, a DC would in fact make more money. There is no rational reason to believe any of the following:
- Health insurance carriers would be willing to pay a DC any more for writing a prescription than for giving an adjustment, if at all
- The health care consumer would be any more willing to get a prescription from a DC than from a MD or DO (probably less so)
- The government / Medicare would accept a DC's rights to prescribe, any more than they accept anything other than their right to do a CMT
- The health care market would actually embrace the idea of a previously self-acknowledged drug-free profession, suddenly doing an obviously self-serving about-face in order to gain some illusory benefit
Fact: There is no separate CPT code for writing a prescription. It is a part of the EM code, but we can already bill for EM, so where's the advantage? In short, this is the absolute worst argument for prescriptive rights I can imagine, yet I fear it may be the biggest driver behind it.
There are so many great, ethical, and lucrative ways to practice chiropractic; for anyone to believe they have to go down this path is very sad. Chiropractic is a noble profession that positively changes and saves people's lives. We have done immeasurable good throughout our history ... and all without drugs.
The "They're Taking Drugs Already, Why Shouldn't We Prescribe Them?" Argument
Boy, are they ever taking drugs already. I believe the reason we've survived the medical war against us is that we aren't like the medical doctors. We are different, we are separate and we are distinct. In the marketplace, it's known as a "position." We occupy multiple positions in the mind of the public. The strongest position we occupy is the one labeled "drug-free." Another is "surgery-free." Another is "natural healer." Another is "spinal adjusting / manipulation" (more on this below). All of these positions, and frankly, our very existence as an alternative form of health care, are in jeopardy if the pharma-practors are successful.
The "What's the Definition of a Drug, Anyway?" Argument
I keep hearing that the "definition" of a drug is any substance used to cause a physiological effect, or to treat a condition, or any number of false arguments. I've even heard some of these people assert that nutritional supplements are "prescribed," as a drug would be prescribed, so why not add to our list of prescriptive choices? This argument is absurd.
The fact is, the Federal Government has already defined what is and what is not a drug. Here it is straight from the Federal Food, Drug and Cosmetic Act: The term drug means:
- "(A) articles recognized in the official United States Pharmacopoeia, official Homoeopathic Pharmacopoeia of the United States, or official National Formulary, or any supplement to any of them; and
- (B) articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals; and
- (C) articles (other than food) intended to affect the structure or any function of the body of man or other animals; and
- (D) articles intended for use as a component of any article specified in clause (A), (B), or (C).
A food or dietary supplement for which a claim, subject to sections 343(r)(1)(B) and 343(r)(3) of this title or sections 343(r)(1)(B) and 343(r)(5)(D) of this title, is made in accordance with the requirements of section 343(r) of this title is not a drug solely because the label or the labeling contains such a claim. A food, dietary ingredient, or dietary supplement for which a truthful and not misleading statement is made in accordance with section 343(r)(6) of this title is not a drug under clause (C) solely because the label or the labeling contains such a statement." (Emphasis added)
According to federal law, articles must meet the definition described in A, B and C listed above to be considered drugs by the Food and Drug administration. So as you can see, supplements are not drugs. Drugs are drugs. Stop clouding the issue with false arguments that we're "already prescribing." We absolutely are not, never were and hopefully, never will.
The "Oregon (Oklahoma, New Mexico, etc.) Has Been Doing It for Years" Argument
No, they haven't. In Oregon, they've had the right to perform "minor surgery" with the use of "antiseptics and local anesthetics" for decades. However even this doesn't allow DCs in Oregon to prescribe any drug. As for Oklahoma, they can inject nutrients and that's all. No "legend" or prescription drugs of any kind are allowed.
New Mexico passed a "limited formulary," but the New Mexico formulary is extremely limited and in no way resembles the full pharmacopoeia and formulary available to MDs and DOs. There are still no drugs in chiropractic and this is another false argument.
The "It's Time We 'Advanced' This Profession" Argument
The introduction of drugs into chiropractic practice is often referred to as an "advancement" of the profession. In reality, it is a bastardization (definition: to make illegitimate) of the profession. This argument of course, assumes that by adding drugs to the scope of chiropractic practice, it is somehow "advanced." I argue the opposite. The United States is literally drowning in drugs, as the latest statistics attest. If all of these drugs were actually good for us, we would be the healthiest country in the world. We're not. The U.S. ranks 47th in the world in most measures of health according to the World Health Organization (WHO).
This is not "advancement," it is nothing less than the demise of the world's last hope of a natural, effective, drug-free, surgery-free form of health care.
To see the alternative future we face should the pharma-practors prevail, we need only look at the osteopathic profession. From their inception in the late 1800s, they were much like chiropractic, in that they had a philosophy of health and wellness that did not include drugs or surgery. Manipulation was their primary mode of treatment. They were focused on what we are focused on: getting people well with their unique philosophy and without allopathic drugs.
But everything changed in 1958. The osteopaths did what the pharma-practors are trying to do. Today, osteopaths are indistinguishable from allopathic medical doctors. Osteopathic manipulative therapy is merely an elective in every osteopathic college, and few take it. Osteopathy, for all intents and purposes, is dead.
The "Look How Successful the Osteopaths Have Been Since They Went Allopathic" Argument
There is already a profession that represents everything the DCs who want prescriptive rights are asking for: osteopathy. Osteopaths are primary care medical providers, they manipulate the joints of the body (at least a few of the "traditional" ones do), they prescribe drugs, and in most states they can perform surgery provided the doctor has the necessary training. They can practice specialties.
I readily admit that the osteopaths have become very well-respected allopaths since they sold out their tradition and philosophy back in 1958. They are virtually medical doctors today. Some states don't even have an osteopathic license any more. Osteopaths are simply practicing under a medical license with a medical scope of practice. This is the model I believe the pharma-practic crowd envies and wishes to emulate.
The osteopaths forsook their history, their philosophy and their uniqueness, and became medical clones. Of course, that's the plan, isn't it: to become just like the MDs (only through the back door)? What with their "cultural authority," their fat paychecks, the respect they command from virtually everyone; who wouldn't want to be like the MDs? Well, I, for one, and there are a lot more just like me who hate what these pharma-practors stand for and what they are trying to do to our beloved profession.
So, I say, just go be an osteopath. But do it through the front door, meaning, go to osteopathy school. Don't kill my profession just because you made an unfortunate career choice for yourself.
Part 3 of this article appears in the Sept. 15, 2013 issue and presents the reasons why prescribing privileges should not be allowed within the chiropractic profession. Part 1 (Aug. 15 issue), as with part 2, refuted the arguments for drugs in the profession.
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.