As we expected, "The Survey Says" in the Feb. 26th issue by Dr. Gregory Baldt, president of the Assoc. for Chiropractic Advancement (AFCA), has generated quite a few letters.
Dear Editor:
I read with a sick feeling in my gut, "The Survey Says," by Greg Baldt and his Association for Chiropractic Advancement. The name of this group should be Association for Chiropractic Abolishment.
He states that we chiropractors should start prescribing pharmaceuticals, thusly adopting the medical model for treating disease, because of our "upcoming battle for the survival of chiropractic." Does not Dr. Baldt realize that the day we begin prescribing is the day we, as chiropractors, have lost the battle?
The sad irony is that one of the national associations, in my opinion, is also steering our profession in this same direction (no, it is not the ICA), and as was just reported in almost every major newspaper and news broadcast, the prestigious New England Journal of Medicine reported that for the first time in modern history, Americans are spending more of their own out-of-pocket dollars for alternative health care (chiropractic, acupuncture, etc.) than for traditional medical care (please reread that statement). Why jump on the bandwagon when it is being driven out of town. The survey may say one thing, but the people of this country and this chiropractor are saying another -- no drugs in chiropractic.
Scott C. Lawrence, DC
New York, New York
"Physicians pour drugs of which they know little, to cure diseases of which they know less, into humans of which they know nothing."
Dear Editor:
I believe the results of Dr. Baldt's "survey" beautifully illustrate the "problem." Let me state that neither my alma mater nor the two colleges on whose faculties I served are "straight" schools. Neither do I practice "straight" chiropractic, although I certainly see its wisdom. Hopefully this will dissuade the AFCA from labeling me a fanatic.
It is not difficult to imagine that a large number of our young chiropractors and chiropractic students may see pharmaceutical inclusion as a viable option. I feel that this is in part due to an insufficient comprehension of the biochemical potential of a healthy human organism. This may reflect inadequate understanding on the part of instructors, but also mirrors the delusion of our society in general. While the government's "war on drugs" focuses on street drugs, it completely overlooks the horrors of iatrogenic pharmaceutical deaths which occur under medical supervision every day. The real war is against the manufacturers, distributors, and prescribers of prescription and nonprescription drugs. Many in our society (and even in our profession, apparently) do not realize that a life without drugs is possible.
Being a drugless profession is not something for which we "settled." Our deliberate interest is in an alternative to the needless medication of millions in the Western World. As Voltaire stated, "Physicians pour drugs of which they know little, to cure diseases of which they know less, into humans of which they know nothing." If we are demonstrating exemplary chiropractic behavior, we are educating ourselves and our patients in ways which their bodies can work efficiently enough to manufacture their potential storehouse of natural "pharmaceuticals." In cases of extreme trauma or crisis, I believe most of us are willing (or even happy) to defer to medical specialists with their battery of drugs, at least until stabilization occurs. This is not a stubborn refusal to relinquish old dogmas, but a solemn realization that drug are not the solution.
If we maintain ourselves as a drugless alternative, the question of competition does not exist. If we do enter that arena, we set ourselves up for failure -- both economically and ethically.
Jennifer F. Zea, DC
Kermit, Texas
"Common Sense Medications"
Dear Editor:
Dr. Baldt's article encourages chiropractic physicians to acquire the ability to write prescriptions for "common sense" medicines. Dr. Baldt suggests to chiropractic physicians who don't want to prescribe these common sense medications to "get your DEA license, but don't use it."
I have several questions for Dr. Baldt. "What common sense medications will you be prescribing?" Does Dr. Baldt realize that a DEA number is necessary for controlled substances only? I know when I write for controlled substances, I don't tell my patients, "These are common sense medications."
What type of training will Dr. Baldt obtain to write for these common sense medications? In the past, we as chiropractors scoffed at weekend seminars that taught manipulation to MDs, dentists, physical therapists, etc., yet he implies pharmacology can be learned in this fashion. I remember a speech by the late Dr. Joseph Janse, saying that anyone can learn manipulation, but it takes years of training to learn the indications and contraindications for chiropractic treatment.
It seems to me that Dr. Baldt is trying to take a shortcut to expanding his scope of practice. In my opinion, this is dangerous to the patients that Dr. Baldt and others will treat. Who will be responsible for the drug interactions and side effects when Dr. Baldt's scripts adversely interact with another physician's prescribed medications? Will Dr. Baldt accept the further responsibility for monitoring renal functions, electrolyte imbalances, dysarrhythmias, pancreatitis, GI bleeding, rashes, anemia, substance abuse, and a litany of other problems, and then be able to treat these problems appropriately?
I realize that other practitioners such as pharmacists, physician's assistants, optometrists, and dentists can prescribe a variety of medications with limited autonomy or, in many instances, MD or DO supervision and final approval. (Remember, prescribing drugs is an integral part of their professional training, not so in ours.) If Dr. Baldt and others want to prescribe medications, get the training you need to prescribe medication safely. Go back to medical or osteopathic school and be trained on how to prescribe safely. Then do a residency (minimum of three years) where you will prescribe medications under board-qualified physician guidance.
Dr. Baldt states that many chiropractic physicians who want to prescribe medications had considered or are applying to MD or DO programs. If these chiropractic physicians want to prescribe medications, I encourage them to take the MCATs and apply, so the patients they care about today will be competently cared for tomorrow.
John Tauro, DC, DO
Milwaukee, Wisconsin
Support Vendors Who Support Chiropractic
Dear Editor:
I just wanted to take a minute to commend you on your article on supporting the companies and vendors who support chiropractic.
After spending 10 years exhibiting at our 300 state, college, and practice management seminars, and working exclusively in the chiropractic profession, I am still surprised when a doctor will ask why he should do business with our company versus someone else.
It's difficult at best to try to explain to them that over those 10 years we have contributed well over $250,000 and will continue to do so. I feel, if you are making a living out of the profession you should contribute back to it.
I would like to tell those doctors that if the other companies cared at all about chiropractic, that they too would spend the time and money supporting chiropractic as we have.
We, as vendors, have all been to state relicense conventions that treated us more as an inconvenience rather than a supporter.
I do not feel there is a serious vendor in the profession that is not keenly aware that sooner or later we will cross paths in the future, and that can be a two-edged sword. If you are not taking care of your clients, they have the right to confront you at your booth, or so it seems to me.
Keep up the good work.
Jess Gibbens
Plano, Texas
Straight Chiropractic, a Specialty in Chiropractic?
It has been proposed that as one solution to the superstraight/straight/mixer controversy in chiropractic is that we create a "specialty straight" branch, and do this in the interest of unity. The reasoning is that the medical profession has various specialty departments and chiropractic may solve its dilemma of dichotomy. Let's evaluate the idea.
As one example, we can cite the psychiatrists who seek to help patients through counseling. By the way, no profession in the world is more "unscientific" than psychiatry, so the medics should not be so quick to point fingers at chiropractic, particularly since a Duke University professor agrees that only 15 percent of all medical interventions are scientifically based.
Let me first say that I consider myself a "straight" chiropractor. I have some therapy equipment in my office but, for the most part, it sits there and gathers dust; so I dust it off once in a while. I am completely satisfied with what we can accomplish with simply giving some good old-fashioned chiropractic adjustments. In fact, it is so good that I am convinced that some day the medics will try to take it over for themselves under the guise of "scientific medical manipulation" and replace and eliminate us, but then that deserves to be a separate article.
As a "straight" chiropractor, I make it very clear that I never treat ailments but rather treat "patients for the ailments." It may sound like hair splitting, but it is an important legal factor, especially if you are ever testifying on behalf of patients. But again, this is a subject for another complete article.
When patients enter my office I determine what is wrong, and if my adjustments will improve their "quality of life" for whatever ailment. I make my "diagnosis" and then treat "the patients" and observe their objective and subjective symptoms. And as they improve, I can logically assume that the adjustments made them better. This is, of course, anecdotal evidence but if our profession can demonstrate that it has some solid "controlled symptom-related outcome studies" to support our contention, then the insurance companies will be obliged to pay our patients.
Now, let's look at the approach of the SCASA people. They don't believe in outcome studies since they feel that results are not relevant to their adjustments. They don't "diagnose" but "analyze" and simply correct vertebral subluxations, and are not concerned with patient's "results" or "outcomes." There isn't going to be an insurance company in the United Stated, or anywhere else in the world, that will pay for these so-called "straight" treatments if there is no benefit to be derived from them. The only reason some of these "straight analyzing and unconcerned results" types of chiropractors are currently collecting any insurance compensations is because of the "diagnosing and patient treating" chiropractors who do concern themselves with outcomes. Once the insurance companies find out that there is a chiropractor functioning on the premise of the SCASA chiropractors, the insurance companies will no longer pay their claims. Why should they? Insurances only pay for treatments to improve the quality of life of patients. The SCASA premise is like putting a gun to your head and pulling the trigger from a standpoint of collecting insurance.
Making the SCASA straight chiropractors a "specialty" within chiropractic would be like putting an oversized anchor on a boat. At the very best it would inhibit the ability of the boat from moving forward; at worst it would sink the boat. The best treatment is to try to talk reason to these people and make them see the light. It might work in another world but not on this planet.
Chester Wilk, DC
Chicago, Illinois
"Dr. Winterstein does not deserve the criticism..."
Dear Editor:
Dr. Keith Innes makes a gentle criticism of Dr. James Winterstein in the March 12th issue of Dynamic Chiropractic, implying that Dr. Winterstein is guilty of a mild hypocrisy for the comments in the Presidents' Forum article in "DC," February 12, yet allowing the States Manual to have a picture of three thoracic vertebrae that have "magically jumped out of place." By his own admission, Dr. Innes did not actually see such a picture; he has been told of it. In point of fact, there is no such picture relative to the anterior thoracic procedures in the book; there is one picture showing two anterior thoracic vertebrae in a short explanation of the National Diversified Listing system And even so, none of this matters.
Let me make just two simple comments. First, the States Manual was published in 1985, several years before Dr. Winterstein became president of the college. Second, even it it had not and had been published during his tenure as president, it would not have made a difference since Dr. Winterstein provides those of us who work at the college the freedom to write and publish material with which he may not personally agree. Not everyone in chiropractic academia has that freedom.
As an editor of that textbook I stand by what it says, and I thank my college for providing me the time and opportunity to publish it. At the least, Dr. Innes' comments are displaced; Dr. Winterstein does not deserve the criticism and it is not for him to have to correct the text or answer to Dr. Innes.
Dana J. Lawrence, DC, FICC
Lombard, Illinois
"... column continues to irritate my chiropractic sensitivity."
Dear Editor:
This is the first time I have written to you or your newspaper, so let me start by saying how much I appreciate the work that you do.
As within any publication, there are items which we do not always agree with. However, one particular column continues to irritate my chiropractic sensitivity. Joseph Keating has yet to write an article which portrays chiropractic without some sarcasm or verbal put down. I understand from others that he is a very intelligent young man. Perhaps I just miss the intellectual humor which he is trying to convey in his articles. No doubt there is some truth in what he expresses in articles like "extravipractice." I think most of us recognize the problems with exaggerated advertising in our profession, and we are critical of those who use these methods. However, to have this type of an article extolling the shortcomings of our profession is offensive and unnecessary. If my information is correct, I understand Dr. Keating is a very good researcher and it would be helpful if he could share his research findings to promote chiropractic, rather than to degrade those areas which we already find embarrassing about our profession.
Arthur R.Turner, DC
Lee's Summit, Missouri
Foray into the Murky World of PR and the Media
Dear Editor:
I have a couple of comments to make: The first is in response to an article by John McDaniel, DC, CCSP, in the February 12, 1993 issue of Dynamic Chiropractic. I wrote the ACA in response to the ad for the mobilization campaign about six weeks ago. I just opened up my own practice and am low on funds, but I offered my services to help. I am well-versed on the newest research supporting chiropractic, so I thought I could help in that manner. Well, I am still waiting; I have received no response at this time. I guess my money was more important than my voice.
For my next comment, I believe you should all be sitting down. The latest workers' compensation studies, the urging of Dynamic Chiropractic to tell the world about these studies, and of course the need to develop a practice promoted me to retain a public relations firm. I wanted to use the firm to help get a press release made. I thought this could benefit me as well as the rest of chiropractic.
After spending a lot of time and a relatively high amount of money, the press release was ready. Three days later I got a phone call from the PR firm. He proceeded to tell me that he had never had such a difficult time trying to get a release in the paper in his career. "What seems to be the problem?" I asked. He then proceeded to tell me that some replied nicely that they couldn't do it for philosophical reasons. One actually told him, "You belong to a respectable PR firm, why are you working with a quack?"
This is 1993. I have a BS from Purdue University, an equally hard-earned degree from Palmer College, and I am a well-respected, life-long resident of Northwest Indiana. You are not going to treat me this way. This is what I wanted to say to the individual that said this, but of course my PR firm does not want to tell me who it was. I guess some individuals are not ready for the truth. In reality, they must not want to challenge the medical practitioners and lose their advertising dollars.
Next time I may have a public relations representative remind the media that in the 1500s the Pope threatened to burn Galileo at the stake for trying to tell people that the sun was the center of the universe and the earth revolved around it.
I guess I should add some good news to this. A couple of papers are carrying the release, and I may have a shot at being on a local TV talk show. If they give me a fair chance, I will get some of the research heard.
Michael J. Matury, BS, DC
Valparaiso, Indiana