"We should open our minds to the possibilities of a stronger and more modern profession"
Dear Editor:
I have read your newspaper's representative sample letters dealing with the issue of OTC medications. [See "Chiropractic and OTC Medications: The Profession Speaks," Feb. 26 DC.] This is a very important issue and I was disappointed to see an articulate letter in favor of expanding the scope of practice, signed by the writer, and then, as a representative sample against changing scope of practice, an unsigned emotional appeal for staying the same for the next 100 years. I hope [the latter] is not true.
I believe that we are in a quagmire professionally and that this unsigned letter is nothing more than the typical, status quo, philosophical and dogmatic response. I think DC could better serve the profession by providing a real polling of what the many thousands of doctors at large believe clinically. We need to both know and accept all the facts if our profession is to survive the next 100 years; a real consensus opinion on the simple OTC antipyretic analgesics would be a good start.
I fell we need a level playing field and full, unencumbered inclusion in all third-party payer systems, as well as in all the various governmental health care programs, if we are to survive and succeed. We should not be hamstrung just treating subluxation. Our chiropractic schools are suffering with low enrollment, our recent graduates default on their student loans at an unprecedented rate, and the failure of doctors in the field is disproportionate to the other professions. Do we ask our leaders why, and do they care?
I have been in practice for over 25 years, I am the third generation of my family to practice chiropractic, and I will tell you what I believe and what I see. However, at this point in time, I would never ask my children to follow me in the profession; I am encouraging them to study for the other health care occupations.
The public and health care payer systems demand cost-effective health care. The public has always accepted medicine, pills, nostrums, potions and surgery. About a hundred years ago, a medical doctor named Tilden stated:
"From the time immemorial man has looked for a savior; and when not looking for a savior, he is looking for a cure. He believes in paternalism. He is looking to get something for nothing, not knowing that the highest price we ever pay for anything is to have it given to us for free. Instead of accepting salvation, it is better to deserve it. Instead of buying, begging to stealing a cure, it is better to stop building disease. Disease is of man's own buildings, and one thing worse than the stupidity of buying a cure is to remain so ignorant as to believe in cures without looking to the cause. The false theories of salvation and cures has built man into a mental medicant [sic], being a slave to a profession that has neither worked out of its own salvation from disease nor discovered a single cure in all the age long period of man's existence on earth."
The chiropractic community, supplied by the vendors advertising on the pages of your newsletter, offer the American public capsules and tablets of various qualities of herbs, roots, grasses, plants, fungi, liverworts, ferns, mosses, trees, flowers, leaves, ocean plants, fruits, vegetables, as well as parts of mollusks and crustaceans that contain many complex chemical substances. Are we being honest with ourselves? Some of the products that chiropractors either unwillingly or knowingly provide their patients have the same desired healing properties (and side-effects) as many of the OTC and prescription drugs our profession seems to endlessly rail against.
Your unsigned writer says we have not changed much in the last 100 years and will not need to change in the next 100 years. I say some members of our profession and leadership are simply sleepwalking and do wish to be awakened; they have their philosophy and they tell us that should be enough. We have changed and we need more change or we will continue to see our market share decline. Like Luddites tearing down the wool-weaving machines, they just have not accepted the fact that Americans are paternalistic and we are not fulfilling the father role.
In the mid-70s, we had classes in pharmacology, pharmacodynamics and toxicology. We were given basic knowledge of medications, but in Ohio, like many states, we cannot have an opinion about a patient taking an aspirin or not taking an aspirin, because it is the "practice of medicine." However, your advertisers include "chiropractic" suppliers that combine vitamins, enzymes and standardized willow bark, the principal source of acetylsalicylic acid, i.e., aspirin, in their "chiropractic products," and that is an "OTC." We are being intellectually dishonest with our patients and ourselves when we bemoan the use of OTCs and promote the more "natural analgesics."
Dr. Steven Woloshin, a medical doctor at Dartmouth University, wrote in Lancet, the very prestigious British medical journal, that the drug companies are not giving the public accurate and balanced characterizations of the risks and benefits of medications in their direct-to-consumer advertising: "Our findings indicate that these advertisements rarely quantify a medication's expected benefit, and instead make an emotional appeal. This strategy probably leaves many readers with the perception that the drug's benefit is large and that everyone who uses the drug will enjoy the benefit."
Misinformation in medical publications, promoted by pharmaceutical sales representatives and the barrage of media commercials, have contributed to and perpetuated this mindset of paternalism. We are equally dishonest, we have countered with nothing ourselves, and we will continue to lose more market share.
Yet, in all this confusion, irrational tribalism and chiropractic diatribe, I see opportunity. I see a chance for our colleges to teach postgraduate medicine to chiropractors rather than naturopathy. I see an opportunity to bring in the big-money pharmaceutical houses to offset the costs of education and an opportunity to excel in integrative medicine while becoming better specialists in neuromusculoskeletal medicine.
We know today that tens of thousands of different biological and chemical compounds, minerals, enzymes, coenzymes, fats, sugars, proteins, hormones and water make up our bodies in a precisely organized, health-sustaining, self-regulating system, and that is what they teach us in our chiropractic colleges. We normally call this process homeostasis, but for sake of philosophy, a few may want to call it innate intelligence. We thrive on being different. Scientists working the world over have unraveled the entire human genome. We know and accept that our cells are genetically encoded with the ability to create new cells, to replace the damaged ones, and that our cells contain all the genetic material necessary to reproduce our species.
I say this because we have made a false idol and have allowed ourselves to become idolaters. We are intellectually dishonest because we have been educated, yet we continue to ignore the facts provided to us in our own chiropractic schools. We suffer from selective learning loss. We have seen under the microscope that an aberration of the process of cellular division is the cause of many if not all cancers. We know that the trillions of cells within our bodies communicate with each other by various chemical and electrical means, yet some maintain that our bone-out-of-place philosophy is the basis of all "dis-ease." We know from studying the neurophysiology of the brain, spinal cord, peripheral nerves and autonomic components of the nervous system that changes in the neural bed can have profound influence over the various glands and tissues of the body, and ultimately, over well-being and health - and yet we are willing to throw away some of the tools.
We should acknowledge that Drs. Stills and Palmer contributed much to the body of knowledge about the spine; information that allows physicians to deliver better care today. We should abandon our tribalism in the arena of patient care. The basis of the ongoing turf war between different types of doctors is more often only about who gets a fee, rather than what procedure is in the best interest of the patient.
We should return to intellectual honesty; we should open our minds to possibilities of a stronger and more modern profession; and I feel we should sign our letters to the editor, or they should not be printed.
David C. Radford, DC
Solon, Ohio
