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Protect Public Health or Allow Freedom of Choice?

Dear Editor:

Your editorial in the Aug. 26, 2010 edition ("Taking a Stand Against Childhood Obesity") regarding childhood obesity and the lawsuit by the Center for Science in the Public Interest (CSPI) against McDonald's "Happy Meals" raises some important issues. It is true that chiropractors occupy a natural place of importance in the discussion of obesity, nutrition and lifestyle. It is also obviously true to anyone with an IQ rivaling Forrest Gump that McDonald's meals, happy or otherwise, for the most part are about as beneficial to one's health as crossing an SEIU picket line. Herein lies the dilemma for those of us who value the health of the public and our rights as citizens in a representative republic.

Our profession is the product of over a century of hard-fought rights and privileges that stem from the freedoms laid out in the founding documents of our country. (I seem to remember something about life, liberty and the pursuit of happiness.) Anyone who has been to a chiropractic convention recognizes that our profession is made up largely of men and women who have chosen to follow a calling that goes against the mainstream and flies in the face of the orthodoxy. In short, we are a professional representation of the ideas that spawned our country: freedom to choose and to be responsible for the decisions that we make. We have, or are supposed to have, the freedom to succeed and likewise the freedom to fail and then hopefully learn from those failures.

There is an observable, ever-growing chorus of elite voices in our culture making decisions about the lives the rest of us lead. Here in New York City, we have a mayor who has come to the conclusion that it is his responsibility to keep the rest of us poor, dumb schmucks from salting our food in restaurants and frying our food in oils that he does not approve of. In the lawsuit referred to and evidently approved of in your editorial, the CSPI has decided to sue McDonald's for the heinous crime of giving away toys in its "Happy Meals." According to the good folks at CSPI, the act of giving away plastic Disney movie merchandise by McDonald's is turning the children of our country into millions of prepubescent Professor Klumps.

These meddlesome, elitist busybodies actually have the cheek to say that because McDonald's has the effrontery to exercise its rights as a corporate entity and advertise these freebies, that children will "pester their parents to take them to McDonald's." Yeah they will. I'll bet the little urchins will also pester their parents to buy cola, Little Debbie snack cakes, Lucky Charms sugar-laden breakfast cereal and Hawaiian Punch.

Where's the lawsuits forbidding them from advertising? Hey, while we're at it, we know that giving children NSAIDS for fever reduction is potentially harmful, as are antibiotics for otitis media - will we file a similar lawsuit against Big Pharma?

The most glaring obscenity in all this is the assumption that the citizens of this country are such dead-from-the-neck-up, mouth- breathing simpletons that parents will acquiesce to the corporate-induced whims of every foot-stamping, fit-throwing toddler. If this is truly the case, then I suggest we close our offices today and start selling Amway or wait tables. After all, our fellow Americans are far too stupid to be swayed to partake in our services due to the nonstop bombardment of pharmaceutical advertisements that permeate our television airwaves daily. How can we expect these gullible, sheep-like morons to overcome the incredible forces of Ely-Lilly and Merck and actually engage in independent, rational thought?

Before we take up the rodent section of the Pied Pipers Nanny State parade float, we might want to consider where this road leads us. If we can force a company engaging in lawful advertising practices to abandon a legitimate free-market activity, what else can we be coerced to do or not do? What happens if these same know-best weasels at CSPI decide chiropractic adjustments are dangerous for children? How about if they decide that, in their infinite wisdom, our Neanderthal populace can't be trusted to buy vitamins at health food stores?

Freedom is a dangerous thing. People are free to be stupid, parents are free to be idiots and do what their 5-year-old child demands. Freedom is also a wonderful thing that, once lost, cannot be restored. Yes, we should of course encourage corporate entities to do what is right. At the same time, we need to remember that the freedom they have to earn profits through the sale of their products, whether cigarettes, Twinkies, Oxycontin or organic blueberries, is the same freedom we rely upon to sell our profession and the services it provides to the public. Without that freedom, without the right of the populace to make their own decisions about how they choose to take care of their health and that of their children, we would have ceased to exist as a profession long ago.

Charles Krieger, DC
White Plains, N.Y.

When Is an MRI Necessary? When You Believe It's Necessary

Dear Editor:

I have been a licensed chiropractor since 1983 and started ordering MRIs in 1989 or 1990. Regardless of whether or not the ACR recommends an MRI, the treating doctor (be it DC, DO or MD) - and only that doctor (not the ACR) - will be culpable and liable if the patient does not progress under care. [See "When Is an MRI Necessary?" by Dr. Marco Lopez, June 17 DC, which prompted this letter.]

Let's say you treat a patient 20-30 times and they improve symptomatically with chiropractic care and conservative modalities. Let's say they have a flare-up six months later and go to their primary care physician, an MD, instead of you. He sends them for an MRI, which shows several disc protrusions with pressure on the thecal sac, plus central canal stenosis.

There's a good chance that the MD will cast aspersions on your care - because you are a DC - and even suggest that your care caused the findings now shown on the MRI. The patient goes to an attorney, who alleges the following: You rendered unnecessary treatment; you failed to make a proper diagnosis per the MRI findings above; your unnecessary treatment injured the patient; the diagnosis you did make was wrong and inappropriate; and you wasted the patient's valuable time, creating an exacerbation of their symptoms, thus increasing pain and suffering because of your negligence. That's exactly what will happen.

Ask my professional liability insurance company: An MRI is necessary when the treating doctor deems it necessary. The ACR is not going to follow you into court, do your deposition or hold your hand while you lie awake at night worrying about your first lawsuit.

There are no absolute reasons to not order an MRI. I don't care what the ACR says. If you need advanced imaging to make a proper diagnosis (see the theoretical findings above) and they can only be discerned this way, then that's what is needed. That's what any experienced physician, nurse practitioner, or physician's assistant does on a daily basis. Dr. Lopez, I can't believe they taught you this in chiropractic school; if yours did, It just shows how out of touch they are.

Seth Allen, MA, DC, DCBCN
Monument, Colo.

What Is Our Future Going to Be?

Dear Editor:

Students often find themselves pondering the future of chiropractic. The decision to open a practice, become an associate, independent contractor, or buy into a practice becomes the focus of attention during the clinical phases of education. Recently, students have been capitalizing on a new trend. They are employing practice management companies to help with these decisions.

Some of these companies prey on students by repeatedly reminding them about mounting student loans in times of a down economy. They offer comfort by making the point that they have all the answers for starting a practice. Their pitch goes like this: "We see anywhere from 700-1,200 patients in a 32-hour work week. We live full lives, spending time with our family and taking long, warm vacations."

It seems as if a profession once built on the concept of helping others has shifted to a profession that is only concerned about patient visit numbers and money. Many practice management groups have accomplished what they have set out to do. The image of the profession has shifted from being patient-centered to doctor- or money-centered. However, one really needs to ask if this is better or worse. The importance of a solid business plan and systems governing practice operations cannot be understated, and good management groups can be helpful in these areas. The concern lies with the unethical practices some of these companies employ to "educate the public."

Chiropractic does not yet have cultural authority, yet there are members of the profession parading around malls and Wal-Marts telling people that the subluxation will kill them. Some practice management groups employ students and "train" them to read scripts designed to "educate" the public on the dangers of the allopathic model. Instead of using a positive message focused on improving health, they opt to criticize and insult people for utilizing medical care.

These groups also preach homeostasis, which is ironic because they practice without balance. They deny the patient's right of informed consent by diagnosing only the subluxation. It is the profession's duty to deal with the attitudes and behaviors of these management groups so that unethical actions are viewed as intolerable and unacceptable.

The message that should be portrayed is not that other health professionals are bad, but that health in general is good. When all options regarding the patient's health are considered, including co-management with other health professionals, the patient and the profession win. Creating and fostering positive relationships will result in respect and additional knowledge concerning other health care options.

The profession has many great leaders and thousands of doctors who are truly concerned about the well-being of their patients. The patient-centered approach must be the message that is shared by all. DCs who rally around money and patient visits are the acid eroding the credibility of the profession.

Others have worked for years to establish respect and acceptance, and as chiropractors, it is essential to improve upon this. Please feel inclined to speak for what is right and to speak louder for what is not. It is important for the profession to hold each other accountable for patient care. Chiropractic is an important piece of the puzzle, but a puzzle is incomplete with only a single piece.

As Theodore Roosevelt stated, "In any moment of decision, the best thing you can do is the right thing. The worst thing you can do is nothing." Make the decision to take a genuine interest in the public's health and rid the profession of doctors who do not.

Nathan Hinkeldey
Student, Palmer College of Chiropractic

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