Editor's note: Our article on the emergence of "orthopractic" has thus far only generated anti-orthopractic mail. The following excerpts from three letters are typical of the mail we've gotten on this subject.
Dear Orthopractor,
If chiropractic is so "unscientific" for you, why still use the D.C. after your name? Frankly this profession doesn't need people like yourself, since it would be better to completely dislocate your "scientific" orthopractic mind from this profession that you still want to be part of.
You know something. You are not going to make it, not now, not this time, not ever.
Leone L.P. Hassiotti, PT, BS, DC
Westwood, New Jersey
Dear Editor,
This group of pseudo-chiropractors probably needs to turn in their licenses and diplomas and return to physical therapy school or medical school. Their definition of themselves closely parallels that of physical therapists or a cross between a physical therapist and an orthopedic MD. If they feel that strongly about forming a new profession, then I strongly urge them to get out of chiropractic and into the medical field.
The chiropractic profession needs to be expanding its scope of practice, not shrinking it.
We are the experts at restoring normal physiology to the body by adjusting and manipulating the body structures. Whether we use hand manipulation, light force techniques, energy techniques or any other nonmedical or nonsurgical procedure, we get good results. If we did not, this profession would have died years ago.
Dennis Baker, DC
House Springs, Missouri
Dear Editor,
... I was greatly disappointed to see the formation of a new splinter group... The greatest deterrent to chiropractic is super eccentric egos that deliberately make an effort to destroy rather than build our profession.Chiropractic in its truest form will eventually come through the storms. I have witnessed tremendous advances in almost 40 years in education, PR, and research.
I do not understand why DCs waste time and money on fringes instead of mastering the delivery of correcting subluxation. Maybe in the next 40 years I'll know.
D.G. Bourns, DC
Palestine, Texas
"... managed care is a viable alternative."
Dear Editor,
As I approach my 12th anniversary of practicing in a managed care environment, I found myself reading Dr. Cianciulli's May 6, 1994 article, "Who Wins -- Who Loses?" with great interest. Dr. Cianciulli clearly demonstrates the lack of understanding regarding managed care that is unfortunately shared with a large portion of the U.S. population. Not only does he not understand the concept, but also doesn't have a clue as to why the U.S. health care industry is shifting in the managed care direction. The benefits for both patient and physician or other health care practitioner, are numerous and in the long run all parties win.
The health care industry for many years has been playing a pyramid game hoping that a younger, healthier work force would be able to subsidize the cost of health care for our aging population. Add to that the notion that "the insurance company will pay the bills and besides we're entitled to get the maximum from our health care benefit" and there's disaster in the making. No longer can we afford to pass the buck to a third-party payer, but must begin to be responsible in what we ask of health care as well as what we provide. After all the public is ultimately handed the bill for excessive services, both demanded and provided.
Out of this has grown, by necessity, what is today termed managed care. Managed care means exactly what it states: not withholding services from patients, not treating patients like merchandise in a warehouse and not forcing them to pay for services out of pocket, but by providing appropriate care using appropriate measures. Managing a patient's health care does not involve hit and miss arbitrary decision making, but incorporates methods of care that have been researched and proven to be effective. And believe it or not, for a growing number of managed care medical groups, HMOs, PPOs, etc., chiropractic is among the methods found to be both physically useful and cost effective. Managing a patient's care also includes eliminating waste and utilizing conservative methods of care. It seems to me that the chiropractic profession has been screaming about wasteful, unnecessary, extreme health care practices in the medical community for years. The most expensive and the greatest number of tests or treatments aren't always in best interest of the patient. However, when waste is eliminated and expensive tests are performed appropriately, more money can be appropriated to those who need the extra diagnostics and care.
As for my own observations, working in a managed care setting has allowed me to treat patients as they need to be treated, without regard to payment for services or restraint on type or length of care for each patient; as long as the treatment is being effective and does not delay the use of other, possibly more appropriate care, and falls within the chiropractic scope of practice. I am also able to attend to patients that might not otherwise consider chiropractic care. Working in a managed care setting has allowed for the establishment of positive relationships with medical doctors, physician assistants, nurse practitioners and other health care providers, not to mention the administrators who work hard behind the scenes to make sure patients are treated appropriately. Although our program allows patients to self-refer, many physicians refer patients to the chiropractic staff (that might not otherwise if they were in private practice), and see chiropractic care as a valid option for their patients.
Patients win by having greater access to health care when it counts the most, in the initial stages of disease. A managed care setting allows for a greater number of specialists to be at hand in case the need arises for referrals. Managed care is good by the patient's perspective because it is affordable health care.
Regardless of the type of practice we are engaged in, ultimately we must all do what is correct and best for our patients. We all rely on our patients for our income and our patients rely on us for help when needed. The U.S. can no longer afford spiraling health care inflation and managed care is a viable alternative.
Gary Pirnat, DC
Chairman, Chiropractic Department
Friendly Hills HealthCare Network
La Habra, California
"...emotional manipulation."
Dear Editor,
With regard to "Thots: Don't Sanction the Shot" by Fred Barge, DC, in the May 6th issue:
I read DC for information, not for emotional manipulation. Most of the material you publish is useful and well documented. I am very interested in objective information concerning the immunization controversy. Unfortunately, everything I have encountered so far is suspect either due to conflict of interest on the a part of the immunization providers, poor research or political bias.
Dr. Barge's article is almost totally composed of extreme emotional imagery. It beings with two emotional allegories, includes an invective by B.J. aimed at someone for some reason unspecified, and an exhortation to fight by Mark Twain. If I am to be convinced to "stand up" and fight for something, I need to understand why, based on clear unbiased facts. Controversial articles may be useful. The only use I can see that Dr. Barge's can be put to is to discredit chiropractic objectives. Please exercise a bit more editorial discretion.
Nelson Gregory, DC
Richmond, Virginia
"The normal healthy prepuce doesn't need `fixing'..."
Dear Editor:
Dr. Barge's article in which he considers one's personal standard, moral duty, conscience or taking a principled decision making stance is appreciated. In this instance the frame of reference dealt with the matter of immunization.
I realize many DCs have taken the path of least resistance that goes with the crowd and demands no standing up to be counted on this issue, and the wimpy instruction in our colleges can be largely blamed, but not entirely, for there are many students who have the strength of character to make the principled stand in spite of lax instruction.
Involuntary circumcision is an unnecessary surgery and a violation of children's and men's basic human rights, but too many DCs have fallen into the trap of errant advice from the medical and religious "authorities" and are guilty of permitting this abuse on their little sons even though the medical and religious myths which created this storm of violence on the North American scene have been disproven.
Lax instruction in our colleges can be at least partly blamed. Other blame must lie within ourselves for failing to reason upon the fallacy that nature would put unneeded tissue into the blue print for male babies. The normal healthy prepuce doesn't need "fixing," and we in a free society should certainly understand the idea of freedom of choice and the right of a baby to his whole body with all healthy body parts left intact for self-determination.
It was only a few short years ago that many of our doctors suffered arrest and legal difficulties in establishing the right of patients to the doctors of their own choice, a form of self-determination, and stood in opposition to unnecessary surgery. Chiropractic first, medicine second, surgery last was an often heard proclamation.
I join Dr. Barge in calling for a massive re-evaluation of our stance on these obviously important issues.
D.C. McKnight, DC Chiropractic Circumcision Information Research Center 405 SE Delaware, #208 Ankeny, Iowa 50021
"...'womb to tomb' adjustments..."
Dear Editor:
I look forward to may issue of DC every other week. I am always anxious to read about all the things that are happening in the profession. I also appreciate the role that DC has played in helping the profession advance itself as a force in the health care world today. Unfortunately, I at times must witness instances in which the profession shoots itself in the foot. And in some of these cases, as in the case of a recent article, it is DC that does the shooting.
The article to which I am referring to is "What Is Wrong with this Picture?" In this article it was reported that a survey was conducted by Palmer College wherein people we asked whether they and ever been to a chiropractor and, if so, if they are still under treatment. Forty percent stated that they had tried chiropractic but of these "only" 15 percent were "currently patients." This was deemed as a lamentable finding in that 85 percent of the patients who have seen a chiropractor apparently were never "educated" to the fact that they should continue to receive chiropractic treatment on an ongoing basis. The question was asked, "What has happened to the message about the benefits of regular chiropractic care?", as if it should be obvious to everyone that in order to be truly healthy one must continue returning to their chiropractor over and over.
As there has never been a single scientific study that has suggested that chiropractic treatment on an ongoing basis is beneficial to people's health, wouldn't it be a good idea to first find out if there is any benefit to "womb to tomb" adjustments before educating the public that they should be receiving them? In this age of health care accountability, I find it distressing that we would still be anxious to publicly advertise our tendency to assume something is true simply because we would like it to be true and we think it might be. With so much talk about the damage that was done to our image by the "20/20" program which put on public display, among other skeletons, the marketing tool used by many among us that serious damage will result to their health if they don't receive regular chiropractic adjustments, even if they feel fine, I am afraid that by incorporating this marketing tool into our Centennial celebration, we will simply be confirming in the minds of most members of the public that "20/20" actually did present mainstream chiropractic.
Perhaps the fact that only 15 percent of people who have seen a chiropractor are not currently under care is a very positive finding. Perhaps it indicates that most of these patients did quite well under treatment, were very satisfied with their result and did not feel the need to return. Perhaps the findings of this study (especially if it is repeated with a larger sample) may help lay to rest the notion that most chiropractors brainwash their patients to continue to keep coming in forever, regardless of whether they need to.
In the present health care environment, it is critical that we take a responsible stand with regard to public education and put an end to this foolishness of making unfounded claims about the benefits of our treatment. If we truly want to survive health care reform, we must educate the public and policymakers that we are constantly striving to decrease the dependence of our patients on continually returning to our offices by getting them health quickly and teaching them to keep themselves that way without needing to get adjusted over and over.
Donald Murphy, DC, DACAN
Westerly Rhode Island
"Congress just doesn't get the 'big idea'..."
Dear Editor,
Aren't you sick and tired of the politics inside and outside the chiropractic profession? While we debate amongst ourselves if we should use hot or cold packs on patients, the U.S. Congress marches on towards health care reform.
Some DCs say we should not be included in any health care reform and we would be better off to go to all cash practices like they did in the 1940s and 1950s. I look at that attitude as a very selfish attitude to take. If the American public is denied reimbursement for chiropractic care in health care reform they will be driven to more dangerous, less efficient, more costly health care due to the pure economics of reimbursement. I do not believe that the American people deserve chiropractic health care as a last resort after suffering from pain or disease for years on end. The American people deserve chiropractic care as a first resort to their health care problems, because we know that chiropractic is extremely safe, very efficient, and less costly health care.
More chiropractic health care is a perfect solution to our health care cost crisis. Chiropractic has been "packaged and gift wrapped" for the U.S. Congress because this is exactly what they are looking for.
Sadly it appears that Congress just doesn't get the "big idea" when it comes to inclusion of chiropractic services in health care reform. While I was in Washington, D.C., in late April, visiting Texas congressmen, they stated they have all received our cost effective studies, but the Congressional Budget Office (CBO) determines that chiropractic care is an additional expense. I was told that during this budget deficit time that Congress is very reluctant to go against the CBO.
I asked a congressman's aide how the CBO comes up with their figures. He stated that the CBO is made up of a bunch of accountants whose job it is to determine the cost of specific programs to the U.S. government. On chiropractic, the CBO would first do a utilization study to determine how many people would use this service, then they come up with a dollar figure on what this utilization would cost. They are unable to calculate if it would offset costs in another area. The CBO states that to expand chiropractic care to medicare or CHAMPUS recipients would add to the federal deficit. I have not seen any CBO figures for chiropractic inclusion in national health care, but I do not expect it to be any different than Medicare of CHAMPUS.
Now I am not a rocket scientist but the CBO figures do not add up (maybe this is why Medicare spending is so outrageous). How can chiropractic health care add to the federal deficit when the overwhelming body of scientific evidence suggests that it is more cost effective when compared to medical care?
This is no longer a chiropractic issue, it is now an issue of what is right for the American people when health care reform passes. I make no apologies when I state that chiropractic inclusion in health care reform is right for the American people. It is safe, it is efficient, it is less costly, and it is right to include chiropractic.
Our forefathers in chiropractic went to jail for what they believed in, maybe now is the time for this generation of DCs to go to jail for our beliefs. Maybe civil disobedience in Washington D.C., could publicize our plight. Maybe we need to occupy a senator or congressman's office or chain ourselves to the front doors of Health and Human Services. Maybe it is time to become radicals. I don't know. All I know is that chiropractic health care is right for the United States of America.
Craig Benton, DC
Lampasas, Texas
A Call to the Profession
Dear Editor:
I would greatly appreciate any helpful therapeutic information for an advanced case of tinnitus which is "driving the patient up a wall."
R. Lipzen, DC
11641 National Blvd., #3
Los Angeles, CA 90064-3834
Tele: 310 479-0343