The big news in the last issue was that Congress passing legislation that requires the Secretary of Defense ("no later than March 31, 2001") to develop "a plan to provide chiropractic health care services and benefits as a permanent part of the Defense Health Program (including the TRICARE program) for all members of the uniformed services."
This is wonderful news. The hard work of the ACA, the Association of Chiropractic Colleges and the doctors involved in the Military Demonstration Project are responsible. We laud their efforts. Great job! (See "Congress Passes Historic Chiropractic Legislation" in this issue.)
But in the back of my mind (or maybe the frontal lobe), the phrase "no later than" set off a warning light. Those three little words seem straight forward enough, but they're fraught with possibilities. This phrase is in the same category as "It's in the mail," or "I'll get back to you."
My first experience with this phrase in connection with government legislation and chiropractic was in the fall of 1992, when President Bush signed the 1993 National Defense Bill. Tucked away in that voluminous document (in Section 505, no less) was the authorization of the Secretary of Defense to "appoint chiropractors as commissioned officers in the armed forces to provide chiropractic care within the military health care system." The Secretary of Defense was required to put such regulations in writing "no later than April 21, 1993."
I took chiropractic about 50 years of effort to incorporate the commissioning language into a bill that was signed into law. What happened to "no later than April 21, 1993?" Well, what happened is that the Department of Defense made like a heavyweight Olympic Greco-Roman wrestler in trouble by heaping its corpulesence flat on the mat to stall for time. After time ran out, the DoD rolled over and made for the showers. Towel-dried and refreshed, the DoD then opted for an end run.
"Let's see ... I know, we'll make them prove that they are worthy. Yeah, that's it, we'll set up a pilot program and call it something like the 'Chiropractic Military Demonstration Project.' We'll allow them to adjust some of our soldiers at some of our bases. We know that chiropractic isn't going to hurt anybody, so we're safe there. Then we'll say, 'Look, we gave you a fair shot, but you haven't proven yourself. We're sorry, but you've been cut from the squad.'"
Thus relieved of commission any chiropractors, the DoD went forward with its plan. In late 1994, the DoD sent letters to five chiropractic organizations* to solicit five chiropractic representatives to comprise an oversight committee for the Chiropractic Military Demonstration Project. (The Assistant Secretary Defense's name was on those letters, as the Secretary of Defense was busy, but I suspect it was the secretary of the Assistant Secretary of Defense who wrote the letter, as the Assistant Secretary of Defense was no doubt playing golf.)
The Chiropractic Military Demonstration (néâ 1995) was set into motion. It was initially set for a three-year run, and began at 10 bases. It soon was expanded to 13 bases. When the three years were up, the DoD still wasn't ready to deal with commissioning DCs, so it stalled by continuing the project for a couple more years.
After five years of the program, the DoD and the ACA/ACC presented their reports. While the DoD admitted good results from the chiropractic care, it contended that it would be too expensive to add chiropractic as a benefit. The ACA and ACC contracted a cost analysis, which contradicted the DoD's findings. Chiropractic in the military would, that report said, save the military health care system $25 million annually.
So, while it's disappointing that chiropractic hasn't been fully integrated into military health care, the chiropractic language passed by Congress is another step toward that goal. The DoD has dragged its feet most every step of the way, and one suspects further delays, despite the "no later than March 31, 2001." We'll see. I hope I'm proved wrong.
(*The five organizations that received the letters were the Association of Chiropractic Colleges; the Council on Chiropractic Education; the Congress of Chiropractic State Associations; the Federation of Chiropractic Licensing Boards; and the Foundation for Chiropractic Education and Research. Drs. Ronald Evans, Peter Ferguson,George Goodman, Rick McMichael, Reed Phillips were selected. (Richard Beecham,DC, was later added.)
The VA Question - Three More Little Words
On November 20, 1999, President Clinton signed the Veterans' Millennium Health Care Act into law. It required the Veterans' Health Administration to develop a policy on chiropractic care for the VA within 120 days. The current VHA policy allows for chiropractic spinal manipulation for musculoskeletal problems of the spine on referral from a VA doctor. The chiropractic organizations testified and presented mountains of documentation to assist the VA in expanding that policy, but the VA, like the DoD, wasn't going to oblige chiropractic. And on September 21, 2000, when the House Committee on Veterans Affairs unanimously passed House Resolution 585 to H.R. 5109 (the Department of Veterans' Affairs Health Care Personnel Act of 2000), chiropractic position's within the VA remained unchanged.
Chiropractic representatives expressed disdain for the VA and some members of Congress for their failure to develop a viable policy for chiropractic in the VA. There were indignant remonstrations and finger pointing, but in the end only the hollow sounds of "Wait 'til next year."
And so, as this year draws to an end, chiropractic is discouraged that there was no progress within the VA, and still no commissioned officers, but is holding out for the DoD's "plan to provide chiropractic health care services and benefits as a permanent part of the Defense Health Program ... for all members of the uniformed services" - no later than March 31, 2001. Mark that date on your calendars!
Steve Kelly,
Managing Editor
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
