Moreover, adverse events of CAM extend beyond the actual treatments themselves. It hasbeen shown that children who consult naturopathy and chiropractic practitioners are signifi cantly less likely to receive the recommended vaccinations and were significantly more likely to be diagnosed with a vaccine-preventable disease.

Over the past 20 years that I've been advocating an intense focus on chiropractic research those admonitions were focused heavily on subluxation based research. Several years ago as the dire nature of the situation became clear to me I further focused my exhortations towards the need for chiropractic research that focuses on health outcomes related to subluxation in pregnant women and children. My reasoning is that given the short amount of time we have to provide the level of evidence that is needed this is the population we should focus on.

So, what can you do to help? Remember what I said earlier about less than 7% of the profession subscibing to a peer reviewed research journal? Here is what you need to do:

1. Join the ICPA and get involved in their research efforts
2. Subscribe to a peer reviewed chiropractic research journal

In order to make your decision about supporting this journal easier please take advantage of this special Mid-summer offer to become a subscriber. If you subscribe to the journal now I will send you, absolutely free, 2 PowerPoint presentations titled:  

• Raising a Healthy Child in an Unhealthy World
• The Role of Chiropractic in Neurobehavioral Disorders - Part I: ADHD

                                                  CLICK HERE TO SUBSCRIBE!

The crucial need for chiropractic research alone should compel you to subscribe and support the efforts of those in the profession trying to gather the data to support what you do day in and day out but hopefully this added special offer will make it a no brainer. Your actions today help support needed research for the future.

And while you're at it please forward this e-mail to a colleague so they can benefit from this special offer. 
 
As always I look forward to your feedback, comments and suggestions.

Matthew McCoy DC, MPH
matthewmccoy@comcast.net
Editor - Journal of Pediatric, Maternal & Family Health - Chiropractic
http://www.chiropracticpediatricresearch.net

"Historically, power complexes begin to falter long before the ruling elite realizes that the oppressed are organizing."

William B. Ferril, MD

I know its cliche - but just when you thought the General Chiropractic Council could not make more bizarre statements than they have already made - they provide more giggles and grins.

But beyond the giggles and grins, the actions being taken by the GCC are serious and have serious repercussions for those practicing in the United Kingdom and indeed throughout the world.

In a response to a letter written to the GCC asking them to reconsider the errors of their ways as well as evidence contradicting their "Guidance" on vertebral subluxation, the GCC opined that after further consideration by the Anglo-European College of Chiropractic that:

"...there is, in fact, no evidence for support of this concept."

The "concept" at issue being that there is a relationship between subluxation and health concerns. 

But then they take the public display of their ignorance of these matters one step further and state:

"Again, the only way to definitively show if the putative spinal lesion has health promoting effects and is as dangerous as some claim is through clinical trials using randomized controlled design."

First, they should get someone to proofread their stuff since I don't know anyone who is claiming that subluxations actually improve health. And second, anyone even remotely familiar with research methodology at this point should know that RCT's are not the only way to determine correlations such as these. Further, the GCC should also know that you cannot "definitively show" anything. All you can do is show varying levels of correlations, probabilities etc. You can never prove causation as any first year biostats student can tell you.   

Scientism at its finest - or should I say worst since they can't even seem to get the science right.

The bottom line is that the Golden Rule prevails here - He with the most gold - rules. And since the GCC has the gold in the way of the annual registration fees of the practicing chiropractors in the UK - they have the money to promote (ahem - enforce) their agenda.

Let's hope and pray for all our sakes and the sick and suffering patients we serve, that the oppressed chiropractors in the UK are indeed organizing.

Additional Links on the GCC Controversy: 

• GCC Correspondence with FSCO
• GCC Guidance on Subluxation
• Analysis of GCC Statement by Christopher Kent DC, JD
• The Bronfort Report
• British Chiropractic Association Statement on Subluxation
• Dangers of the Quack Therapy of Chiropractic
• GCC Advice from European Schools
• The Death of the Subluxation
• GCC Guidance on Vertebral Subluxation - Letter to Public 
• Foundation for Vertebral Subluxation Response to GCC
• The Ridding of Philosophy in Chiropractic Educational Programs

Matthew McCoy DC, MPH

matthewmccoy@comcast.net
Editor  
Journal of Pediatric, Maternal & Family Health - Chiropractic
http://www.chiropracticpediatricresearch.net
     

Beyond the narcissism in these reality television, talent contests, survivor shows etc., what amazes me is that chiropractors actually think that getting a chiroprator on Oprah is going to save this profession.

And please don't write me and tell me about all the careers she has launched and best selling books she has put on the lists, yada, yada, yada.

Once more let's get this straight:

The future of the chiropractic profession rests on its ability to demonstrate improved health outcomes secondary to reduction and/or correction of vertebral subluxation coupled with its ability to communicate that benefit and provoke outrage within the public to the extent that they perceive there is a hazard of leaving verterbral subluxation unattended.  

This is the only thing that is going to move us from seeing less than 10 percent of the population - the early adopters - and move on to the rest of the population. Oprah won't do it, being primary care physicians won't do it, prescribing drugs won't do it...
            
The perfect storm of the health care collapse consisting of unsustainable spending, GDP percentage approaching 20+ percent, entitlements, social security, aging baby boomers, Medicare and Medicaid is coming in the next 20-30 years. We'll either be out in front of it or we will be swept up in the tidal wave of reform.

While Oprah has miracle powers, she does not have influence over 20 + percent of the gross domestic product of the country. I beleive that intellectually chiropractors know this but deep down from the roots of our profession we are always looking for that one charismatic person who rides in on a white horse to save us from our oppressors.

I got news for you - NO ONE IS COMING TO SAVE US.

And that includes the entrenched leadership within the profession which is perfectly happy with the status quo - 30 years from now they will effectively be gone and had their fill of the bounty of this profession.

Well - the status quo has to go. And the only way it will happen is for each and every one of you to get engaged in the process.

Or we could pin our hopes on Oprah.

Are you in?

Matthew McCoy DC, MPH
matthewmccoy@comcast.net
Editor  
Journal of Pediatric, Maternal & Family Health - Chiropractic
http://www.chiropracticpediatricresearch.net
     

If you have not read the Foundation's response and Dr. Kent's Analysis - you should. But just in case, I'll give you the Cliff Notes version:

You can't just make crap up!

And this is exactly what the General Chiropractic Council did.

While we are all affected by what the GCC has done it remains to be seen whether or not the chiropractors in the UK will come out swinging or not. If there was ever a time and if there was ever an issue where their regulatory board does not have a leg to stand on - this is it and they should be all over it like a pit bull on crack. 

As Dr. Kent suggested - it's as if they were contending the earth was flat.

That is how ridiculously stupid this is.

As always I look forward to your feedback, comments and suggestions.

Matthew McCoy DC, MPH
matthewmccoy@comcast.net
Editor  
Journal of Pediatric, Maternal & Family Health - Chiropractic
http://www.chiropracticpediatricresearch.net

This has been one hell of a spring and as we slink into the summer it seems the rancor in the profession is heating up as well. We are no longer a drugless profession, nothing other than musculoskeletal claims can now be made, the "united profession" has taken up the role of physician as a national legislative priority and rumors are that the state regulatory bodies in the US are working on defining chiropractic in a whole new light. 

In what will no doubt become a major historical event in the history of the chiropractic profession the United Kingdom's General Chiropractic Council has declared that there is no research to support the vertebral subluxation  as a cause of health concerns.

Some are heralding it as the death of the subluxation.

It appears that following the Simon Singh case and the release of the Bronfort Report numerous complaints have been filed against chiropractors for claims being made other than those on the short list allowed in the Bronfort Report.

The GCC made the subluxation statement in a response to an enquiry by a member of the public. In addition to the statement about subluxation and health concerns the GCC stated that subluxation was "...synonymous with joint misalignment, joint dysfunction, facet syndrome and articular derangement."

There is certainly no mention of the imprisoned impulse!

Keep in mind that the GCC made this statement after consulting with the chiropractic educational programs in that country.

It appears that these institutions teach subluxation within a historical context - i.e. we used to believe...

You know - like we used to beleive the earth was flat.

I trust everyone understands the significance of the GCC making such a public statement.

Still don't think the sky really is falling?         

As always I look forward to your feedback, comments and suggestions.

Matthew McCoy DC, MPH
matthewmccoy@comcast.net
Editor  
Journal of Pediatric, Maternal & Family Health - Chiropractic
http://www.chiropracticpediatricresearch.net

“Goodness gracious me!” said Henny- penny; “the sky’s a-going to fall; I must go and tell the king.”

Yes, we all remember that fateful day when an acorn hit Henny Penny on the head and she along with Cocky-locky, Ducky-daddles, Goosey-poosey, Turkey-lurkey and Foxy-Woxy went off to tell the king.

Unfortunately it was off with their heads.

For some time now I’ve been running around like Henny Penny, Chicken Little and any other character who thought there was some impending doom pressing down upon us. But unlike the boy who cried wolf, what I’ve been warning about within the profession has systematically come to pass and the only ones getting their heads lopped off are chiropractors.

The current brouhaha involves a myriad of interconnected issues including the introduction of drugs into chiropractic in at least three states that we know of, the imbroglio in Texas between the Texas AMA and the chiropractic board (which apparently began over the issue of MUA and will no doubt spread to other states) and the full scale adoption of primary care physician status as one of the top priorities of a United Chiropractic Profession 

As if we needed any more acorns hitting us on the head!

Nevertheless the Brits and Aussies were happy to oblige.  First we had the Simon Singh fiasco which has morphed into a large scale attack on the chiropractic profession in the UK with rumors circulating that anything beyond the treatment of neck and back pain will be outlawed.

Indeed, in a report written by Gert Bronfort and commissioned by the United Kingdom’s General Chiropractic Council only the following conditions can be advertised:

 Acute, subacute and chronic low back pain;
 Migraine
 Cervicogenic headache
 Cervicogenic dizziness
 Extremity joint conditions
 Acute/subacute neck pain
 Chronic neck pain

Fears of large scale rounding up of chiropractors who have anything about wellness or subluxation based care on websites are heavy on the minds of chiropractors on the other side of the pond.   

This of course because there are not enough (or any) RCT’s for anything else chiropractors claim to treat. What makes this really scary is that it appears the powers that be are moving beyond this to make chiropractic care, or claims, for general health improvements off limits as well.

Makes me recall the sage advice of Ian Grassam DC - "Stick to subluxation and they can't touch you" 

The rumors are that in Australia, the Board is proposing changes that include restricting the forms of advertising used, curtailing wellness type care, discouraging the recommendation that parents get their kids checked regularly and even that chiropractors will need to be up to date on all vaccines.

I know some of you right now are swooning at the thought of such things and righteous indignation is setting in as you harrumph, harrumph wildly while reading this but can you honestly say you did not see it coming?

Are you going to try and convince me that you were not aware that the controlling cartel in this profession has a plan and it does not include what you hold so dearly? I guess I could forgive you if you’ve been held hostage by a water boarding Jack Bauer in some underground warehouse.

But its time to wake the hell up folks! The Dark Side’s ducks are all in a row. It’s done, over with, kaput. The only thing left is for them to put it into play and that’s what they are doing now.

What we see happening now is the bringing to market the harvest of the seeds that have been sown over the past 20 years by those whose agenda was to seek control of the profession as a short term treatment for musculoskeletal pain. All the while the leadership in the subluxation camps told us we needed to stay involved with them because we could “change it from within” - in the immortal words of Dr. Phil: “How’s that workin’ out for ya?”   If you can’t connect the dots you didn’t watch enough Sesame Street.

So where does all this leave us? Pick up your pitchforks and torches and get ready to storm the castle and avoid like the plague anyone who says we can change them from within. Anyone who says that has their own agenda and their own retirement they are worried about.  Nothing short of a revolution in this profession is going to right this ship. And those that don’t want it are just too concerned about whether or not there will be enough lifeboats for them.

Subluxation, family wellness focused chiropractors need to take over the regulatory boards, agencies and organizations in this profession – “Trow da bums out!” so to speak. You may not agree with the teabaggers but they are being effective.

We need a massive research effort like never before seen (focused on subluxation, Quality of Life & health outcomes) and we need a massive public relations/marketing program to go along with it. This marketing campaign needs to do what health communications experts call “provoke outrage” but unfortunately this is exactly what the regulatory boards have outlawed.

To recap:

1. Politics – Trow da bums out
2. Research – Subluxation & health outcomes
3. Marketing – Provoke outrage

Spinal manipulation? 

The PT’s are coming, the DO’s are going back to their roots and the MD’s can learn it at Harvard now.

How long will it be before they see a “miracle” scratch their heads and say “hmmmm - there must be more to this after all”.

As always I look forward to your feedback, comments and suggestions.

Matthew McCoy DC, MPH
matthewmccoy@comcast.net
Editor  
Journal of Pediatric, Maternal & Family Health - Chiropractic
http://www.chiropracticpediatricresearch.net

I don't believe I've received as many letters about any single topic in the nearly 20 years I've been writing within the chiropractic profession as I have on the issue of tiering and drugs. I've heard from long lost friends, classmates, students, academics, researchers, college presidents and every other part of the chiropractic spectrum. I've heard from those both for and against and from those who simply don't care (not sure why they wrote then). Some have been downright nasty and unprofessional. Makes you wonder.

The majority of the feedback I have received has actually been pro drug and pro tiering. I can only hope that those who oppose such efforts are simply apathetic and that's why we've not heard much from them. While it might seem strange to hope for apathy, the alternative is perhaps worse - that those who oppose drugs and tiering of the profession really are in the minority.

It certainly jives with the only data we have on this from the McDonald Ohio Northern University study which said about 50% of the profession wants to be able to prescribe drugs. Since it’s been a number of years since that study was published it would not be a stretch for that percentage to have grown and given the current economic circumstances and the changing demographics of the profession I suspect the number of chiropractors willing to abandon its drugless nature has indeed grown.

In the April/May issue of Today's Chiropractic there are two essays on the topic of tiering, drugs and the loss of the separate and distinct nature of the chiropractic profession. One is by Joseph Brimhall DC, President of the University of Western States and the other by Rob Sinnot DC, one of the leaders within the Chiropractic Philosophy Diplomates. If you get Today's Chiropractic you can read these articles for yourself or you can "Friend" Dr. Sinnot and read them on Facebook

Here’s my summary of Dr. Brimhall’s pro-drug/pro-tiering argument:

1. We need to accept and understand change
2. Chiropractic has endeavored to be separate and distinct since its beginning
3. Authority to establish scope of practice and chiropractic definitions are assigned to the states
4. Lawmakers, government administrators and the public decide our scope and how we are defined
5. We'll remain viable and distinct as long as we meet the needs of the public
6. Scope changes (such as bringing drugs into the profession) is not tiering or an indication of superiority because the individual chiropractor can narrow or broaden their scope as they desire within the law.
7. Failure as a profession will come only if we abandon the needs of our patients in favor of our personal definitions of chiropractic.
8. Some patients require more invasive procedures so why shouldn't we provide them?
9. If we are more concerned about our identity then the needs of our patients we have already lost
10. We should become part of the health care solution and worry about distinction later.

Let me state at the outset that I respect Dr. Brimhall and the work he does within the profession and I believe that he really cares deeply about the profession and the public. He has fought hard for reform within the profession and I do not think that his opinions reflect anything other than a sincere interest in professional stewardship.

While there are many facets of that distinctiveness I think it could be reasonably argued that the most significant is the drugless nature of the profession. 

What I find myself reminding people of these days is that the potential for chiropractic to no longer be a drugless profession is not some vague possibility off in the distant future – it has already happened. With the events that have taken place in New Mexico, the similar efforts being undertaken in Colorado and Utah, and National’s establishment of an Advanced Practice Degree - the profession can no longer claim to be drugless. In fact, it appears we have quite a contradiction on our hands considering all of the associations, organizations, schools and trade groups that proudly proclaim that the profession is drugless. All of this has to now be re-written.  Talk about confusing the public! We‘ve gone from a profession suffering from a multitude of neurotic tendencies to a complete psychotic break. 

Dr. Brimhall argues that the “…authority to establish scope of practice and chiropractic definitions are assigned to the states and that lawmakers, government administrators and the public decide our scope and how we are defined…”

While this might be true I doubt the general public is storming statehouses with pitchforks and torches demanding that chiropractors prescribe drugs. Of all of the arguments I’ve heard this is stretching it the farthest.

The general consensus among those I’ve heard from, or in articles I’ve read in support of drugs in chiropractic, appears to be that it makes financial sense. Yes, as always – its all about the Benjamins baby. You see, the ability to prescribe drugs and the ability to perform injections opens up additional diagnostic and procedural codes for us to bill insurance carriers. The Mercedes 80’s generation of chiropractors just cannot give up on finding more and more creative ways to get money from third parties. And I’m sorry but no one is going to convince me that if the prospect of increased revenue were not in play that we would even be having this conversation. The pro-drug movement should just admit this outright.

Dr. Brimhall asserts that we'll “…remain viable and distinct as long as we meet the needs of the public.”

I’ve heard this argument many times from the pro-drug wing – but it doesn’t make sense to me. First, it supposes that the public needs drugs – or least they need us to provide them with drugs. Not sure about you but it seems to me that the medical-pharmaceutical-industrial complex is doing just fine providing drugs to folks. Is the public really in such dire need of more drugs that arguably the most powerful industry in the world needs the help of 40,000 chiropractors to help market and deliver their product? 

We’ll remain viable as long as we provide our unique (distinct) service to the public and educate them about what exactly that unique service is. And it’s not the episodic treatment of musculoskeletal pain syndromes, weight loss, exercise, proper diet, vitamins, proper sleep or a positive mental attitude.   

Dr. Brimhall contends that scope changes (such as bringing drugs into the profession) “…are not tiering or an indication of superiority because the individual chiropractor can narrow or broaden their scope as they desire within the law.”

If only this were true. I’m not saying the following to impress anyone but only to impress upon you that I just might have a little experience in this area. For nearly 20 years I have served as an expert witness and/or consulted on behalf of chiropractors battling malpractice, regulatory and insurance issues. We’re talking thousands of cases at this point. Anyone with half his wits about him knows that this profession is controlled by the more medically oriented faction of the profession. They control the state boards, they control the schools, they control accreditation and licensing and they control the research infrastructure.

To suggest that the more conservative factions of our profession should just trust that these entrenched powers will allow one to practice a narrow scope focused on the analysis and correction of subluxation is simply insulting. We are talking about the same entrenched powers that have historically, and up to the present day, sought to exterminate the more conservative factions.    

Failure as a profession, Dr. Brimhall suggests, “…will come only if we abandon the needs of our patients in favor of our personal definitions of chiropractic.”

I could not agree more.

Every single national and international chiropractic organization has endorsed the ACC Paradigm Statement. This statement, developed and signed by the Presidents of all of the North American Chiropractic Colleges, has enjoyed unprecedented endorsement throughout the chiropractic profession. It has received such widespread support that some have remarked that never in the history of the profession has there been this extent of agreement on anything. This statement has been endorsed and/or adopted by every major national and international chiropractic organization in the profession including:

Chiropractic is a health care discipline which emphasizes the inherent recuperative power of the body to heal itself without the use of drugs or surgery.

As I said – the profession has some rewriting of its basic premises to do.

The point is that we’re not even talking about personal definitions of chiropractic – this one is signed by everybody!

The repeated mantra from the pro-drug rally that we are abandoning the needs of our patients by not providing them with drugs makes no sense – and making matters worse the profession has abandoned its own paradigm to do so.

But expediency seems to rule the day as Dr. Brimhall argues that “…some patients require more invasive procedures so why shouldn't we provide them?”

Some patients need their tires rotated – should we do that too?

Stating that if we are “…more concerned about our identity then the needs of our patients we have already lost,” Dr. Brimhall brings forth a common argument I hear on this issue.

I suggest that being concerned about our identity is part and parcel to being concerned about our patient’s needs. We’re talking about identity here. Ever deal with someone who didn’t know who they were? As Dr. Gerry Clum recently wrote on the issue of drugs:

“This only serves to strengthen my perspective that this is an area of health care (drug use) better left to others totally immersed in it, trained in it and supervised heavily in it.”

Are we really trying to convince people that 12, 24, 36 or 48 weekends in a Holiday Inn learning how to prescribe and inject drugs qualifies us to do it? People better start reading the briefs on the AMA v. Chiropractic in Texas. The full body diagnosis and treatment charade is about to end for everyone. You mean I can get into chiropractic school, spend $200,000.00, have 300 patient visits, graduate and then diagnosis and treat the human body when I get out just as much as I could if I went to Harvard Medical School? Who do we think we’re fooling? This is just further evidence of our break with reality.

Dr. Brimhall finishes his essay by stating we “…should become part of the health care solution and worry about distinction later.”

Sorry Joe, but the only way we are going to be part of the health care solution is through our distinction.

As always I look forward to your feedback, comments and suggestions.

Matthew McCoy DC, MPH
matthewmccoy@comcast.net
Editor  
Journal of Pediatric, Maternal & Family Health - Chiropractic
http://www.chiropracticpediatricresearch.net

I realize that much of your time is probably devoted to focusing on the needs of your patients and running your practice. That's a good thing.

But while you are doing that please realize that there are forces both within and outside of the chiropractic profession trying to stop you from being able to do just that.

Just recently the British Chiropractic Association lost a lawsuit against a self proclaimed skeptic of chiropractic for children. As stated in The Guardian:

"The British Chiropractic Association was suing him for saying that there was 'not a jot of evidence' that its members could help sick children by manipulating babies' spines in accordance with the teachings of a more-than-usually nutty American faith healer."   

http://www.guardian.co.uk/commentisfree/2010/apr/18/nick-cohen-simon-singh-libel
 
Personally, I'm not interested in getting into what he should or should not be able to say at this point or how simply ignorant any of these people are - its a waste of time and you might as well try to teach pigs to sing.  What I am interested in is putting to rest once and for all the question of whether or not chiropractic care is safe and effective for children.

And the only way that is going to happen is through research. Period.

And please don't write to me and tell me that we don't need to prove anything or that we just need to educate the public, blah, blah, blah.

If at this point in the dismantling of health care delivery you do not understand that we are moving rapidly into an outcomes based reimbursement system then you have your head buried in the sand. If we had another 100 years, doing it one spine at a time might work. But we don't have 100 years - we have 20 if we're lucky.

So do a couple of things RIGHT NOW:

Do it now.

As always I look forward to your feedback, comments and suggestions.

Matthew McCoy DC, MPH
matthewmccoy@comcast.net
Editor  
Journal of Pediatric, Maternal & Family Health - Chiropractic
http://www.chiropracticpediatricresearch.net
 

If you haven't heard the latest news in the health reform movement it is the announcement that Obama has appointed Donald M. Berwick as the Director for Medicare and Medicaid. I consider this to be very big news - even if he ends up being marginalized and has his hands tied for the next several years.

Why is this big news and why should we as chiropractors care about this?

I've been writing over the past few years that the chiropractic profession is in the midst of a 20 year perfect storm. The perfection is in the storm however - not necessarily its outcome. its made up of several things ocurring simultaneously within the profession, within the larger culture of health care and within the larger societal culture in which health care operates.

I rarely take a stand on an issue or espouse an opinion regarding an issue with an attitude of certainty. But on this issue I have few, if any, doubts.

This perfect storm includes the slow painful march towards payment for health care based on outcomes. That's where Berwick comes in - he is a leading, if not the leading, guru on this subject. When children born today reach their 30's and 40's they are going to look back at the dark ages of health care and wonder what the hell we were thinking. "You mean you had a system of health care where people actually paid for things that didn't even work?"

With all its faults organized medicine does not have the outright disdain for research that our profession has. So while its going to be painful for them to go through this - its nothing compared to what our profession is about to experience. You are going to have spent $200,000.00 and 6-8 years of your life to treat a very narrow range of neck pain, back pain and headaches. Release the imprisoned impulse? LOL.  The general disdain for research in this profession is bad enough - within the various subluxation based factions it is even worse.         

Add to this that within chiropractic we have the 40% decline in chiropractic college enrollment that has ocurred over the past decade.

 

I predict that several of the smaller chiropractic programs are going to fold up their tents in the next 5-10 years which will consolidate enrollment in just a handful of larger schools. I predict that enrollment will remain flat, as it has for several years, and even inch downward a bit.

This will happen for a few intertwined reasons. Students no longer enter chiropractic soley because they had a personal experience that changed their lives or because they had a family member who got them into the profession. Most are entering because they simply made a career choice. The savvy health sciences student absent a life changing chiropractic event or being brought up in the TIC is considering chiropractic, osteopathy, medicine, physical therapy, pharmacy, dentistry etc in terms of a career choice. 

The savvy potential student is weighing the costs of a chiropractic education with what he will get at the other end. Given that it costs about the same $200,000.00 to become an osteopath or MD as it does to become a chiropractor and given the perks, discounts and sign on bonuses being offered by pharmacy programs and drug stores to become a pharmacist, and given that physical therapists are now doctors, have primary care status and are fully integrated into the health care system - the potential chiropractic student has much to weigh.

Chiropractic's move away from being drugless and its embracing of the primary care physician designation in order to get paid for more codes has just further diluted our brand. On the other end of the spectrum there is the move to present oursleves as all things "wellness" to the public when we don't own the patent on that either. Why spend $200,000.00, four years, four parts of the National Boards etc to do what any gym rat or stay at home mom can do? $200,000.00 to tell people to eat right, exercise, get proper rest and have a positive attitude?

I spoke to a graduating student recently with $200,000.00 in student loans who was asking advice about what to do after graduation. His plans included setting up a practice by borrowing over a $100,000 with his parents co-signing and putting up collateral. Oh, and by the way his wife is also about to graduate as a chiro, and they just had a baby and are buying a house. Nearly a million dollars in debt between them and they haven't seen a single new patient yet.

Our profession needs to take a serious look at itself politically, academically and research wise if we are going to survive this storm. And I'm not talking about individual chiropractors. I know very well that an individual chiropractor can see hundreds of patients a week and make millions of dollars a year. But the average chiropractor won't - and those seeing 500, 600, 1000 a week (and getting paid for each visit - not the $10 and I'll see your whole family BS) are in the tail of that normal distribution. Yes, its possible - but not probable.   

And just where are those 1000 + a week practitioners in terms of the politics of the profession? Are they speaking up about the direction a small rogue faction of the profession is taking us? What about the groups that train them? Are they mobilizing their armies of chiropractic warriors to unseat the entrenched powers in the profession? Are they donating gobs of money to fund the research we are going to need in order to even be an afterthought in the coming outcomes based healthcare system?

Because it is coming whether we like it or not. And its coming no matter how hard we click our heels together and wish we were back in Kansas.

Will this third generation of chiropractors be the last? Will those in the second generation who made money in the Mercedes 80's and now make it by running schools, teaching students how to run a practice after they graduate, and selling their wares to the new graduates dare upset the status quo? Will they worry more about the sacred trust and responsibility for the stewardship of the profession than they worry about their own retirement?   

These are important questions as we arrive at the proverbial fork in the road.

Will we embrace our singular uniqueness in the marketplace or will we marginalize ourselves by becoming third rate providers of whatever we can sell today?

Is chiropractic in us or are we in chiropractic?

As always I look forward to your feedback, comments and suggestions.

Matthew McCoy DC, MPH
matthewmccoy@comcast.net
Editor  
Journal of Pediatric, Maternal & Family Health - Chiropractic
http://www.chiropracticpediatricresearch.net