There was no doubt what I would write about this month. Two of chiropractic's leading adversaries were busy doing lectures at various colleges trying to influence the impressionable minds of future medical and physical therapy students.
The lectures are obviously inflammatory and replete with outright distortions of some of the facts, but others are challenging the profession and need some serious consideration. As I was viewing these lectures on my office computer, I reflected a bit on how things have changed.
Years ago, our slow-moving world allowed us the luxury of taking time to respond to allegations and, to quote a common phrase, "What happened in Vegas, really did stay in Vegas," simply because there was no instant means of disseminating the information. There was no cable TV, YouTube, MySpace or any of the other multimedia communications possibilities. It's difficult for me (and impossible for anyone younger than age 30) to imagine a world without faxes, express mail, computers, e-mail, satellites, interactive news, cell phones, digital cameras, texting, MP3 players, GPS devices and credit card alternatives. Today, just as supersonic speeds have made the world small and high-tech computers have made information fast, everything is moving at breakneck speed. We are now forced to look at everything, including our profession, in terms of not just where we've been or where we are, but also where we're going. In an instant, tomorrow is now, with no time for sage reflection and thoughtful response.
I see this changing media speed as chiropractic's greatest challenge. Not medical competition, government intervention, economics or even managed care or third-party reimbursement. These are important, to be sure, but somewhat shortsighted in the overall scheme of things. The fact of life is that crises come and go and many of them are the same, simply wrapped in different packages. If history repeats itself, it's only because each generation refuses to read the minutes of the previous meeting.
I'm not concerned about crises. They are to be expected. Just as Henry Kissinger cleverly said, "Don't tell me about another crisis. There cannot be another crisis next week; my schedule is already full." I am not concerned this profession will face crises in our future. This is to be expected. What I am concerned about is whether this profession has geared up to meet the challenges of the new world.
Are we ready, as a profession, to step into the bright light and scrutiny of a sophisticated and scientific world, or do we want to continue to hide in the shadows of dogma, entrepreneurism and anti-science? Those lectures caused me to do some reflecting on where we are as a profession in 2008.
I have traveled extensively over the past 40 years and have learned valuable lessons in those years of travel. One of the pleasures and personal satisfactions I get from flying is the privacy and quiet time to think and to read. Most of it is substantive and some is pure trivia. However, there is some benefit to trivia sometimes.
Trivia fact: Do you know that of all the people who have lived to age 65 in the history of the world, more than half are alive today? Does that tell you something about where health care is headed in the future?
Trivia fact: According to the CEO of a major insurance company, more than 50 percent of premature deaths just 20 years ago were attributed to self-induced problems such as smoking, drinking, weight, diet, lack of exercise and stress. That statistic has improved ever so slightly, but we have a long way to go. Does that tell you anything about the need for preventive care and a wellness health care approach for the next century?
Trivia fact: Do you know it costs about 10 times as much to drill a tunnel as it does to build a bridge? At this point, maybe you're thinking, "What's that got to do with health?" I admit, nothing. But as an analogy, it does have a lot to do with the chiropractic profession if you let your mind wander a bit.
Up until now, chiropractic has been an underground profession. Since the beginning of the 20th century, our profession has struggled every inch of the way under all the barriers imposed upon us by society and the organized forces working against us. Rather than meeting offensive forces straight on, we have tunneled and crawled under what we perceived as obstacles, carrying with us the burden of nonacceptance, nonconformity, cultism, internal dissent, paranoia, lack of scientific evidence and just pure unprofessionalism. We have burrowed our way, many times, under barriers and dirt kicked up by our colleagues.
Through hard work, dedication and endurance, chiropractic was able to go from obscurity to recognition, from ignorance to enlightenment, from dogma to science, in a matter of 30 years. That was the first leg in chiropractic's long, hard trip; a 100-year trek.
Now, chiropractic is into the first decade of the 21st century and influenced by a new world. Like the famous groundhog, Punxsutawney Phil, we have come out of the hole and there is no shadow. The light is bright and the sun is dazzling. Chiropractic has entered the world of computers, satellites, technology, communications and, most of all, science.
Now comes the challenge and the decision. After listening to these anti-chiropractic spokesmen, do we want to go back in the hole for another 100 years and hide from the sun? Do we want to continue to dig tunnels and try to circumvent the system at a slow and very costly price, and take the chance that the whole structure will come tumbling down on us? Or do we want to do it the easier way by coming out, shedding our protective fur and starting to build strong bridges? Let's build bridges with:
- the medical community and other health care providers;
- government and administrators;
- insurance carriers;
- the media;
- industry;
- the research and scientific community;
- each other (rebuild what's been destroyed over the years); and
- the most important group - the patients we have been privileged and selected to serve.
Now, some people in our profession will say building bridges means giving up our individuality and identity, surrendering our philosophy and abandoning our principles. The question that always follows in my mind is: What would have happened to the world if the caveman had been content to isolate himself to darkness? My opinions are rather obvious and equally as strong. Any group or profession can live in isolation. We can't be oblivious to other professions or the rest of the world, and what they say or think about us.
- We must be cooperative.
- We must be professional.
- We must be responsible.
- We must have standards.
- We must practice with the highest ethics.
- We must be accountable not only to ourselves, but also to others.
And we can't forget our mission, which is not necessarily to build the largest and most lucrative practice, but rather to conscientiously and effectively serve the needs of our patients. Our rapidly advancing research efforts will result in chiropractic procedures and hypotheses being tested and measured. Chiropractic's benefits will become tangible - and thus more acceptable and understandable - once the scientific foundation is solid.
But there is another dimension that is intangible and that is attitude. As doctors of a different model, we must know not only what makes the heart beat and the spine erect, but also what makes the mind tick and the soul feel. I just read a brief survey from my home state sent to practitioners to help with a particular legislative effort. The response was so typical: "Yes, it should be done, but I'm too busy." "Too busy" is not good enough for a profession of only 60,000 non-united, disparate individuals attempting to work in unison.
How long will we be satisfied with a fractured identity? How long will we be willing to withhold our knowledge from those who need us to be mentors? How long will we continue to tolerate bad conduct, even if it comes from that small minority in the profession? We simply can't afford, morally or legally, to look the other way anymore.
The Katzes and Kinsingers of the world are now poised to jump on everything not properly aligned in our profession. Despite the huge documentaries on medical misbehavior, drug abuse and unnecessary surgery allegations, their cultural authority will cause them to survive. The anti-chiropractic forces don't need millions of dollars or huge organizations; they need only the Internet, YouTube and a reporter or two who is more than willing to promote negative publicity. They are only too welcome on medical college campuses because vestiges of old-line AMA bias and prejudices still linger. How well I remember the line uttered by Judge Susan Getzendanner in the AMA conspiracy trial: "The lingering effects of this [the AMA conspiracy] will take generations to overcome." How right she was.
I urge you to listen to the video presentations by these two individuals and ask yourself: How much of what they say is really true? Then ask yourself: How much of what they say can I impact and change? They speak about our theory, hypothesis, practice mode, fringe groups, dogma, lack of science and limited research, but mostly the fear factor of stroke being caused by manipulation. We know differently, and science and research will prove them wrong. Fortunately, we have significant research to support the mechanisms of injury and to refute allegations of causation. If you have not seen, read or heard about the research, the full reports can be accessed by subscription on the Spine Web site (www.spinejournal.com), or purchased from the FCER at www.fcer.org. It's important we arm ourselves not with bullets and lawsuits, but with information and science.
We can only combat the Kinsingers and Katzes of the world by supporting valid, legitimate research efforts and promoting the profession in a credible manner. The cultural authority we are gaining as a profession is difficult to earn and easy to lose. The lingering effects of the Katzes and Kinsingers do not have to last for decades; we can accelerate the process with efforts by our colleges, our licensing boards and our own personal involvement. Ask yourself: "What can I do to help?" Then do it.
References
- http://cme.med.mcgill.ca/html/videos/2007.tels/murrayKatz/video.html.
- http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv.
Click here for previous articles by Louis Sportelli, DC.