On Remaining Chiropractors…

“If you’ve got a job, keep it.” This is what the manager of my local convenience store said to me when I went in for a cup of coffee this morning. Bob mentioned to me last week his father had been a shoemaker in the town next to my clinic for 50 years and was about to retire when he passed away suddenly a few years ago. Bob related to me the reportedly minor health issue his dad went to the hospital with and that they gave him the wrong med and before his family could blink his dad was in a coma and they had to ultimately, “Decide to pull the plug”.

I don’t know about you but stories like this make me grateful to be a chiropractor and keep me motivated to push every day to educate my patients about their body and the difference between sick care and wellness care and the importance of addressing the subluxation as part of this scientific and vital process. Still, every day I wonder if I will be able to keep my job. Here in the US there is an environment of fear about the economy and world resources. When I speak with people these days this is what they are talking about. Many people have stopped doing anything they perceive to be non-essential in their lives. This makes me wonder how essential they perceive their chiropractic care to be and how they are being educated about chiropractic.

I am not a lawyer but it is my perception the governing board’s who issue licensure to chiropractors, at least in the US, are responsible to ultimately protect the general public against chiropractors. These boards have been charged with the responsibility of deciding what laws to advocate for chiropractic in their state to best accomplish this goal. When reviewing individual chiropractors they make judgment based on the most prevalent available information based on what the profession advocates, what the research shows and what is considered standard of practice. When so many chiropractors practice so differently from each other and have potentially different clinical goals for their patients this task easily becomes confusing. To further confuse the matter, groups and individuals within the chiropractic profession often misrepresent what information actually exists. Many push for a pain management, symptom based model for chiropractors to follow and many push for a purely vitalistic approach. Many claim there is no science to support subluxation treatment and in my experience, even most chiropractors I meet are unclear about what our own research says and its’ implications. It is no wonder the research is so easily misrepresented.

I want to help give lawmakers tools to make laws to support chiropractic. I want the lawmakers and policymakers to understand there is strong science in support of treating subluxation. More so than even wanting lawmakers to understand this I would like chiropractors to understand it. At a party several weeks ago I met a chiropractor from another state. I told him he should go online to www.IcaBestpractices.Org and take the online survey there. I explained to him I feel we are fighting an environment of fear and apathy within our own profession and that if action is not taken to critique and provide constructive and honest feedback on this current draft of these ICA Best Practices and Practice Guidelines, laws might be made in far greater favor of a pain management model of solely spinal manipulation treatment. This chiropractor had just finished speaking with me about how important addressing subluxation is to him in his practice. He had just finished explaining he thought the policies of third party payers in his state and even the state board in his state had policies on how he should practice which are far too limiting for him to help his patients to the extent that in his experience and in his training they need and desire. When I told him this Best Practices document is the strongest current piece of advocacy for chiropractors to use existing research and the implications of chiropractic research to support subluxation based treatment and that if the profession stands behind it then chiropractors will have even more power to help their patients, he had one simple comment for me. “I have a cash practice so I don’t care about any of that stuff.” I asked him what he would do if the state he practices in limits him by law based on other organizations recommendations for chiropractic treatment parameters. To this he said, “I’ve been in practice for years. They’ll never do that.” I don’t know about you; I for one am not getting rich being a chiropractor. My patients pay my very reasonable fee and because they hire me to help them, I strive to understand their goals and give them options in the extent of care we can offer them. I shutter to think one day the law might limit me to offering merely pain relief care. I am also not a gambler. I don’t have the nerve to sit back and believe laws will not be made to restrict my ability to help my patients. In my opinion it is my duty as a chiropractor to protect my patients against the creation of healthcare policies which will restrict my ability to use the knowledge I have about the body and about chiropractic to help them to the greatest extent of my ability.

There is a trend in the mainstream medicine toward, “Evidence based medicine”. This is a problem for chiropractors when few people in our profession can agree on what the evidence actually says or which evidence to look at when making these considerations. Also as a result of this are the erroneous claims on what research actually exists. Just not too long ago a major insurance company sent me an email announcing they could not support chiropractic care for children or headache sufferers. My recollection was the reason for making this policy was a lack of supporting research.

When looking at the published indexed peer reviewed literature it turns out there is plenty of supporting research on chiropractic and pediatrics and also on headaches. The ICA commissioned myself, and a host of other chiropractors, most of whom run successful practices, to read, summarize and computer-catalog every piece of existing chiropractic research published since the beginning of time. In doing this our group has created a searchable database to end the confusion about what research chiropractors actually have to support what we do. This database represents real chiropractic data. It was created because of the ICA but in fact the research statistics within it are generic to chiropractic research as the research represents all chiropractic groups. We used original research only. There is no discrimination based on who published that research. It is this research which is the backbone of treatment and duration recommendations made by the ICA in chapter 11 of the document. Though the document is a strong advocate of the importance of the individual doctor’s experience and the individual patient’s desire for help as well as the doctor’s commitment to treating subluxation, the document is written with the world of Evidence Based medicine in mind. This is the current language of lawmakers, policymakers and third party payers.

Why? As it turns out the research shows it takes about 25 visits of chiropractic care to achieve significant improvement for a symptom. What the research does not show is how complex the scenario gets when treating subluxation. It also does not show how much more care should be considered necessary when more than one problem exists. If co-morbid factors are present such as measurable subluxation, diabetes, obesity, sleep deprivation, stress at home or in the workplace, history of trauma or multiple occurrences of a chronic problem; based on the published research it would seem 25 visits should begin to look simply like a start. For those of you with cash practices who are aggravated by this conversation, what evidence and what support will you provide lawmakers in your area to allow you to continue practicing the way you want to without restricting you to minimal symptom relief treatment or basing procedures like radiographs on red-flag only parameters?

Chiropractic needs you to look through the ICA Best Practices Guidelines Draft document and take the online survey. We don’t need a small panel of people deciding what we should do in the absence of, “determinate answers (eg., hard data or well established theory)”¹. In reality both hard data and well established theory do exist in chiropractic. Let’s speak out in defense of our patients and not ignore this fact.

1. http://www.fernuni-hagen.de/ZIFF/v2-ch45a.htm: The Delphi Methodology by Norman C. Dalkey, co-creator of the Delphi Methodology.