In the paper, Eisenberg reported that during the time of the study one in three respondents used at least one unconventional therapy, and one in four who saw a medical doctor during that time also used an unconventional therapy. There were 425 million visits to providers of unconventional therapy at a cost of 11.7 billion dollars, outweighing visits to primary care medical physicians during that same time. The most common providers of that unconventional care were chiropractors.
Consider also the following recent developments:
- the creation of the first chair of complementary medicine in the United Kingdom at Exeter University;
- the movement of the Phillip Institute of Technology's chiropractic program into the Royal Melbourne Institute of Technology's department of chiropractic, osteopathic and complementary medicine;
- the creation of several new journals devoted to alternative medicine: Alternative Therapies (with at least three people devoted to chiropractic on its advisory board -- Drs. John Triano, Anthony Rosner, and myself), Journal of Alternative and Complementary Medicine, and Complementary Therapies in Medicine (published in the UK);
- the creation of the Office of Alternative Medicine at the National Institutes of Health, originally known as the Office of Unconventional Medicine. It had a chiropractor on its ad hoc advisory board (again, myself), and used a representative of the chiropractic research profession as a general advisor (again, Dr. Anthony Rosner). I was even fortunate enough to have written the entry in the Chantilly document on the profession.2
Does it matter what we or others call ourselves? Are we "alternative" or "complementary," or are we mainstream? What advantages or benefits can be derived from being perceived or defining ourselves as "alternative?" Well, one is that it might help to position us in the eyes of the public as something different from allopathic medicine, that is, it could be used essentially as a marketing tool. It allows us entry into areas where we had been shut out in the past. It could open doors for use that were traditionally closed.
However, in terms of real impact on real patient care, it poses a number of risks:
- We chance that our services are less likely to be recognized and therefore funded by government and/or other third-party payers, especially in light of the move toward evidence-based medicine. That is, if little "proof" exists, it won't get funded; everything outside the mainstream is generally perceived in that manner by lawmakers and politicians.
- It makes it so much harder to create partnerships with medicine, osteopathy, hospitals and other more "accepted" mainstream providers.
Yes, chiropractic can rightfully claim to be holistic, and perhaps it is indeed complementary. I would argue myself that it is conservative and mainstream.
However, I am but one person and I cannot claim to speak for the profession. The issue regarding whether we are alternative, complementary, unconventional or mainstream and conservative is one that needs dialogue. This dialogue must not be limited to traditional areas of strength, such as the United States by simple virtue of its great number of chiropractors. It should involve the many different countries where chiropractic has made itself felt, through the auspices of the World Federation of Chiropractic (WFC) as the organizing group. Country organizations can discuss the issues with its members and bring to the WFC its issues, concerns and points of view. The WFC can then help to reach consensus on the issue, leading to international agreement.
I implore you all to begin consideration of this issue as soon as possible. The world of health care is changing continuously and will not wait for you.
References
- Eisenberg DM, Kessler RC, Foster C, et al. Unconventional medicine in the United States: prevalence, costs and patterns of use. N Engl J Med 1993; 328:246-252.
- Berman BM, Larson D, editors. Alternative medicine: expanding medical horizons. A report to the National Institutes of Health on alternative medical systems and practices in the United States. Washington, DC; United States Government Printing Office, 1995.
Dana Lawrence, DC, M. Med. Ed., MA, is the senior director for the Center for Teaching and Learning at Palmer College of Chiropractic and interim senior director for continuing education and events.
Dr. Lawrence is past editor for several professional scientific journals for the chiropractic profession, and has published a number of textbooks. He serves on numerous editorial boards. He was a member of the Alternative Medicine Program Advisory Council of NCCAM.
In addition to his DC degree, Dr. Lawrence has earned master's degrees in medical education (M. Med. Ed.), and bioethics and health policy (MA). He is a co-investigator on Palmer College's R25 grant, "Expanding Evidence-Based Medicine Across the Curriculum," for which he has helped coordinate faculty training designed to enhance the use and understanding of evidence-based practice by both faculty members and students. In addition, he also teaches a course in evidence-based chiropractic practice.
In 2013, Dr. Lawrence was named "Academician of the Year" by the American Chiropractic Association for his service to the profession.