Food for Thought 2000

Food for Thought 2000

G. Douglas Andersen, DC, DACBSP, CCN

Volume 18, number 3, 1/25/00, page 36
In my initial consultation I tell patients what kind of chiropractor I am.

Last fall I read an article that blasted the Research Agenda Conference IV (RAC IV) because Dr. Ian Coulter recommended that our profession abandon the antiquated subluxation theory.1 The article said that 90% of those in attendance agreed with Dr. Coulter. I was very disappointed I missed the conference. It made me happy to know that there are those in leadership positions who realize that our profession's survival in the next century must be based on science.

Even though people like Don Petersen plead for chiropractors to work together, the differences may be too great for one profession. Our profession is so diametrically opposed in so many areas that a split may benefit both camps. Imagine how hard it is for a wellness chiropractor to convince a new patient that they need 20 treatments a year when that patient's previous DC had a "treat and release" practice.

Conversely, how many thousands of people have been turned off by those who practice with a "philosophy" geared toward overutilization driven by greed? Where is the literature to support the "catastrophic effects" the vast majority of the people on this planet supposedly suffer because they are not receiving regular manipulations? Where are the insurance studies to prove that people who go to the chiropractor 15 or 20 times a year, whether they have pain or not, have fewer injuries, less illness, longer lives, or lower health care costs?

When I consult a new patient, I have to waste valuable time to inform them what kind of chiropractor I am. I have to tell them that:

· I don't take x-rays unless a history and examination indicates they be performed.

· If I do take x-rays, they will not be used as a marketing tool.

· I will not manipulate their asymptomatic neck to relieve the symptoms in their lower back.

· I do not diagnose nutritional deficiencies by having them hold a vitamin while pulling their arm.

· I will do everything indicated, including numerous types of soft tissue therapy and modalities, to eliminate their discomfort as soon as possible.

· I will not try to brainwash them to bring in their asymptomatic family members.

· I will try to educate them about diet, lifestyle and exercise to prevent a recurrence of their problem.

· I will inform them that if I cannot help them, I will find a health care professional who can.

I understand there are many who feel that a "real" chiropractor would not practice this way. Fine. If being a real DC means wellness care, asymptomatic care, excessive x-rays, poor working relationships with MDs, rejection of scientific data, bizarre techniques, outrageous claims, and the same treatment each visit regardless of the problem, then I don't want to be a "real" DC.

The only thing "real" DCs and I agree upon is that we would both like the public to look at our title and have an idea of what we do. Maybe all DCs would benefit if those of us who reject pseudoscientific subluxation-based philosophical chirobabble (designed to addict the world to manipulation) had a different title. I would proudly introduce myself as a medipractor, a treatipractor, a physical medicine therapist, a doctor of chiropractic medicine, or whatever it would take to inform the public there is a basic difference.

In any profession, there will be differences in how one approaches various conditions. Generally speaking, healthy scientific debate benefits both patients and clinicians. However, I fail to see any common ground between those who try to see each patient as many times as possible, regardless of symptoms, and those who see each patient as few times as possible to eliminate symptoms. Maybe the best way for both sides to flourish in the new millennium is with a formal division.

For Dessert ...

Last summer, I was flipping through a stack of Johns Hopkins Medical Letters called "Health After Fifty." An article on new arthritis drugs caught my eye.2 The article focused on the new Cox-2 inhibitors, which had 2.5 million prescriptions written in the first three months they were on the market. The good news was that these drugs only killed 10 people and only caused an additional 11 to be hospitalized with internal hemorrhage. This is a much better record than traditional arthritis drugs (non-steroidal anti-inflammatories, a.k.a. NSAIDs) which, according to the authors, cause 75,000 hospitalizations and 7,500 deaths in the United States each year from internal bleeding.2 The article also touched on additional options for the treatment of osteoarthritis, which included half-dozen different types of surgery.

This piece made me quite angry for two reasons. First, imagine the uproar if chiropractors, acupuncturists, naturopaths or massage therapists caused even a fraction of the morbidity and mortality that is attributed to NSAID "treatment" of arthritis every year. Second, the article did not mention nutritional supplements at all. This spring, we will take a closer look at the question, "Does American academic medicine have an anti-supplement bias?" Stay tuned.

References
1. McCoy M. Research conference urges profession to dump subluxation. The Chiropractic Journal 1999;13(12).

2. Health After Fifty. Johns Hopkins Medical Letter August 1999;11(6).

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