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