Rebuilding After a Flood: A City or a Profession?

By Louis Sportelli, DC

The aftermath of Hurricane Katrina has raised a number of questions applicable to situations far removed from the battered Gulf Coast. Undoubtedly, some who read this column will be intellectually stimulated and motivated to seek new answers. Others will be angry and begin the usual name calling and misrepresentation that always happens if an article hits too close to home. Still others will not fully recognize the longer-range vision and wonder about the relevance of this article.

One of first questions asked with respect to dealing with the aftermath of New Orleans was (albeit quite briefly) whether it really makes any sense to attempt to rebuild in that location at all. After all, a catastrophe of such proportions had long been predicted. The city is essentially below sea level. The reclamation effort will be gargantuan and will seemingly rebuild an area that simply cannot be protected from what all indications point to: a more frequent and higher-intensity barrage of storms in the future. Whether that meteorological reality is the result of global warming or merely a recurring, multi-decade cycle is disputed, and for my purposes today, largely irrelevant.

There is also the subsidence of the coastline and the land under New Orleans, because of the oil rigs pumping crude oil out of the gulf. Ironically, the crude is piped to refineries around New Orleans, driving the local economy with the raw material whose removal is sinking it. There may be an analogy for the profession here - the behavior that keeps it and some of its larger egos fed today is eroding its foundation for sustainability and future growth.

The "New Orleans Question" should perhaps be addressed in a longer-range analysis than I've seen explored so far. My question is: In 500 years, won't we, in all probability, have lost New Orleans? (And, I suppose in all probability, most of California?) How many times will it have been rebuilt during those centuries? At some point, doesn't it just make sense to face up to reality and conclude that under the most lenient cost/benefit analysis, we ought to just let it go?

Now, before you get upset, I'm not seriously arguing for abandoning New Orleans right now, but the 500-year picture has made me wonder at what point we should "give up" in the face of repeated failure. Of course, I don't advocate "giving up" at all, so I guess my question is, at what point should we come up with an alternative strategy or approach to a problem, rather than throwing years and tons of money at simply rebuilding the problem?

As often happens with me, and I suspect with many of Dynamic Chiropractic's readers, when "big questions arise" or "big events" occur, I eventually end up thinking about them in terms of relevance to chiropractic. I guess when you are involved in this profession and it is your vocation and avocation, everything is about chiropractic.

Rebuilding in the wake of Katrina reminds me of the fundamental tenet of chiropractic: Let's fix the problem, rather than just treating the symptoms. The debris on the Gulf Coast is only a symptom. The underlying problems (disease) are topographical, meteorological, and technological. Until we find a way to reverse or at least contain global warming, for example, isn't rebuilding New Orleans just a big prescription of OxyContin, masking the displaced residents' pain until their next acute onset of a hurricane?

Of course, the reconstruction effort in Louisiana will attempt to fix at least the technological problems. They'll doubtless build stronger levees, a more dynamic pumping system, But as long as the underlying forces remain uncurtailed, isn't it always a game of playing "catch-up"? More pills? Higher doses?

Is there a more practical relevance of all this to chiropractic? Do we have any analogous professional "problems" that we need to approach from a new perspective? Are we so busy cleaning up our professional "debris" and rebuilding practices that will only be beset with the storms of time? Are we really only treating our own professional symptoms, rather that seeking out and seeking to "adjust" our profession, so that it can better function?

I submit that the answer is a resounding Yes, and offer the following for your consideration:

1. If New Orleans does survive another 500 years, will there be any chiropractors to practice there?

I don't know that we've given any serious thought to a 500 "plan." We seem only to plan from crisis to crisis. Nor am I certain that there is really any way to do so, other than as a study in science fiction. Nonetheless, the point is that perhaps we should start thinking in "bigger" terms. These are a few rhetorical questions we should be asking ourselves. How far ahead can/should we "plan?" Is 100 years too far? Are we continuing to fight a losing battle in seeking to maintain professional "independence?" If so, is it time to start focusing more attention on being absorbed into a bigger health care culture - much as many Katrina "refugees" will simply put down new roots in Galveston, or Atlanta?

Isn't that essentially what many multidisciplinary practices are doing already? Isn't that essentially what many practitioners who are developing and nurturing referral relationships with MDs doing already? Isn't that essentially what many new avenues of practice, e.g., military, hospital and research, are providing as new opportunities?

If that's where we're going to end up in 100 years, are there more efficient, economical and practical ways to go about it? Shouldn't we be undertaking some thoughtful "scenario planning" to explore every possible option for our future?

And for those among the profession who don't want to end up there at all, and in fact are already railing against the "dilution" of "true" chiropractic, isn't it time to forge a coherent alternative plan, rather than just fighting each battle as it comes along? There are no right answers, but the questions have not been addressed; only the battles de jour continue. Aren't we reacting to professional adversity, as surely as rebuilding New Orleans is a reactive, rather than a proactive stance?

2. Are we allocating our resources any more prudently or with any more in-depth analysis than the tens of billions of dollars of "aid" that will be thrown at New Orleans?

The outpouring of money, volunteers and compassion for Katrina victims has been heartwarming. We truly are a remarkable people in times of crisis (looting, finger-pointing and political and economic opportunism to the contrary notwithstanding). But isn't most of the "giving" more reflexive than analytical? Isn't it just the easiest reaction? Some tragedy has occurred; let's throw money at it.

How differently do we as a profession react to adversity? Some court case comes along that narrows our scope and we immediately start drumming up "donations" for our PACs to lobby for some perceived legislative remedy ... or "begging" for legal action funds to finance some clarifying "test case." Have those efforts paid dividends? Of course they have; think about Wilk v AMA and dozens of examples of legislative expansion of the practice.

Likewise, will all the money thrown at Katrina pay dividends? Of course - the city will be rebuilt, the construction industries will thrive, and the national economy will doubtless have significant stimulation. But the question I'm asking is not whether there are short-term benefits, but whether New Orleans will just flood again; whether the new Mississippi casinos will be reduced to splinters again; whether there'll just be another court case we have to finance.

Aren't we hamstrung by this short-term focus? Aren't our resources being too dominantly focused on "fixing" what amount to symptomatic problems?

3. Are we dealing any more effectively with our professional "looters" than the New Orleans police did with theirs?

This is a familiar theme for me and I won't burden readers by rehashing what I'm talking about. You know whom I consider to be our "looters": the over-utilizers, the opportunists, the incompetents.

The New Orleans police largely ignored their looters, the rationale being that there were more important things to do - saving lives, performing rescues, conducting evacuations - all doubtless true. Nonetheless, while there was so much heroism, so many daring rescues and so many poignant reunions; for many, the most indelibly etched picture of the disaster is the footage of the seemingly gleeful vultures wading through the floodwaters with their arms, garbage bags and makeshift skiffs stuffed full of loot.

For viewers already cynical or otherwise predisposed to find fault with the victims, these relatively few wrongdoers gave them all the ammunition they needed to condemn them all. I suggest it's the same for us. There is much heroism in our profession. We make "rescues" every day; certainly not as dramatic as a helicopter ride from a rooftop, but often as meaningful to our patients. Helping our patient regain a more normal life with fewer symptoms is our very lifeblood.

But for viewers already cynical or otherwise predisposed to find fault with us, don't you think the images most indelibly etched in their minds is that of the chiropractor being hauled off to jail for fraud? Or losing his or her license for sexually abusing a patient? How many times a day during casual conversation do our potential patients hear: "Well they may do some good ... but God, they want you to keep coming back forever." Or "You really have to watch them; I saw in the news that..." Public opinion is formed and the perception created lingers longer than the facts.

I submit to you that our "looters" are stealing from us just as brazenly as those plundering New Orleans.

Do I have the answers to all these questions? No, certainly not. But I firmly believe they need to be asked and discussed, and that we (the collective profession) and the public we serve will benefit from our at least trying to answer them.

As I watch the Katrina rebuilding effort, with all the attendant setbacks and advances it will doubtless generate, I'll probably see other parallels, challenges and opportunities for our profession. I invite you to join me in using this natural tragedy to help us think about how this could impact on our profession.

One very immediate program, the Campaign for Chiropractic, which has just been launched from the Foundation for Chiropractic Progress (F4CP), may prove to be the first step in the right direction in helping to rebuild our profession. The program is designed to help increase market share for each and every doctor of chiropractic in the United States. Will it be perfect? No! Will it satisfy every single DC supporter or critic? No! But it will be the first start we have made as a profession to begin to rebuild the damage of 100 years of chiropractic invisibility. For those of you who really want to help the chiropractic victims, you can contribute to the foundation, which will be analogous to sending a contribution to the Red Cross. It is important that the profession begin to shed the mantle of second-class citizen and victim mentality and begin to demonstrate by our collective actions that we want to have a voice in our destiny. We can only do that one DC at a time, each contributing and each helping to make this rebuilding work.

I am reminded of the cartoon about three kinds of people: Those who make things happen, those who watch things happen, and those who say, "What's happening?" Hopefully as we probe these 500-year questions, there will be more in the profession who will want to make things happen.

Louis Sportelli, DC
Palmerton, Pennsylvania

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