We Don't Have to Prescribe
Dear Editor:
I am clearly not alone in thinking that "drugless therapy" and allowing the body to use its innate intelligence to heal itself is central to chiropractic, and I deplore the CCE's attempt to take this central tenet out of the definition.
However, none of the discussion I've seen thus far has addressed the elephant in the living room: Most of our patients are on drugs prescribed by someone else, sometimes for a situation that no longer exists. In some cases, they are so overmedicated their lives may be in danger. It is not difficult to ascertain this; merely looking up their drugs in the PDR is often enough.
In my practice, I had a patient who had paralytic ileus secondary to an attack of shingles over the left lower ribs, not surprisingly affecting the activity of the diaphragm. A gastroenterologist put him on amitriptyline for hiccups once. What was the side effect of amitriptyline as listed in the PDR? Paralytic ileus! I mentioned this, of course, but had no legal right to recommend discontinuation of the drug. As far as I am concerned, the true value of an "advanced practice" allowing drug prescription would be drug unprescription.
We should be all means study drugs, as they are a fact in our professional lives and often interfere with what we're trying to do. We don't have to prescribe them if we don't want to, even if we live in states with "enhanced" scope of practice (which most of us don't). I personally have no interest in giving injections or prescribing NSAIDs, but this may be important in some people's practices, and if they are willing to study the subject and live somewhere where it's legal, they may at least be more mindful about how they do it than many MDs.
Nancy Offenhauser, DC
Amenia, N.Y.
A Matter of My Perspective
Dear Editor:
Addressing the article written by Douglas R. Briggs, DC ("Things I Have Learned: A Matter of Perspective"), I must compliment the author on his writing abilities. On the other hand, the subject matter he wrote on and how he addressed it are quite disturbing. Yes, I agree that we must not fall into the mundane or canned treatment methodology. Chiropractic can be subject to the same pitfalls as the other professions. However, comparing chiropractic to allopathic medicine is like comparing apples and oranges. You cannot, for the most part, do it. To me, the innuendoes in the article hail a threat not just to me but to the chiropractic profession.
Without giving a colleague any initial opinions, I called and asked him to read the article and give me his impression of it. He soon called back with the same concerns and opinions I offer here.
I have been in practice for 26 years. I have seen a lot of opinions and perspectives come and go. Dr. Briggs' perspective, in my opinion, could very well be the most toxic and dangerous one ever presented to the chiropractic profession. The morning that I wake up and become a single spinal region adjuster is the day I have lost my entire philosophy, science and purpose as a chiropractic physician.
In one small article, he has attempted to unravel all of the years of my education and experience of being a total system healer, a true chiropractor. If any system, workers' comp or otherwise, makes it a crime to practice as we were taught in our philosophy and science, then it is that system that needs to be questioned, not us.
It is reasonable to expect that we provide reasonable documentation that correlates our findings, technique and science as it pertains to the presenting condition. How can an outside entity have the right to tell us (or any physician, for that matter) how to treat a patient as long as we are practicing within the boundaries of our state laws and education? In doing so, they are endangering the patient by disallowing the doctor to provide treatment that is in the patient's best interest. I believe that in legal terminology, this is referred to as interference.
The challenge that was put to the chiropractor in Dr. Briggs' article and the chiropractor's reply of, "I practice full spine," followed by Dr. Briggs' reply; can he [Dr. Briggs] document a neck problem associated with the lower back injury? In what context does he ask this question? Was the neck injured too? Probably not, but the chiropractor - being a full-spine practitioner - realizes and is educated on the fact that the spine is an integrated system, which benefits most when treated as whole. As chiropractors, this is our science, this is our specialty.
This paradigm of practice Dr. Briggs is helping to inflict upon our profession is not, in my opinion, chiropractic, but stands to be the progeny of the allopathic science and insurance system. Who, if given the opportunity, would love nothing better but to define and control our profession? Again, if we as full-spine practitioners are trained to perform as such, then it is the imposing system that is wrong and not us. And yet Dr. Briggs' response to the chiropractor's full-spine comment was, "You must be able to show the thought process for the care you render; anything less may be construed as reckless and negligent."
I would like to believe this sentence was intended as a constructive statement, but to me, the statement swings with an ax of contempt and the seed of negative propaganda intended to scare a profession, bringing it to a degree of undesirable submission. I cannot answer for the chiropractor being questioned, although I can imagine all of the answers he could or would have provided, given the time to do so. What we do is complicated, and not always along the same line of thought or acceptance as our allopathic colleagues. In other words, what we do cannot always be answered with an orthopedic test or whatever mainstream medicine may expect or desire.
If, for example, his client were suffering from a shoulder condition and examination revealed pelvic deficiency with lumbar subluxations that directly influenced posture involving the affected shoulder, as a full-spine practitioner I can easily accept why a full-spine correction is necessary for the best outcome. How do you define a vertebral subluxation complex? Is it by X-ray? Spinal EMG? Spinal palpation prone or standing prone? How about the fact that our spine is not made of a system of isolated biomechanical processes? How about the fact that the spine is a machine that works in such manners; one region usually, if not all ways, affecting the other?
A subluxated region will frequently affect another region of the spine. I feel I have concentrated my opinions as a full-spine adjuster, but also need to include doctors who practice the art and science of upper cervical technique. This category of professional has mastered a very useful technique and is able to help many a malady. Their treatment is effective for many conditions far removed from the upper cervical spine. Yet I do not think they are" reckless or negligent" just because they may not be conforming to the model Dr. Briggs is illustrating.
Our profession obviously needs to commit further into research to justify our science and art of healing to the world, but I do not believe the answer is that we conform to the opinions, impressions and science of the allopaths and the insurance industry. What is it worth to gain the world if it means you lose your soul in the process?
Arthur L. Eberting, BS, DC, FIACA, FASA
Clinton, Mo.
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