The lion is fear about the future, and the roars we hear are the dire predictions about health care reform. Some in our profession are stampeding to expand chiropractic services to include prescribing drugs. Others want to limit our practice to back pain and headaches. Both extremes suggest we are still intimidated by the medical profession. Either course could result in our being swallowed up.
A group calling itself the Association for Chiropractic Advancement (AFCA) is attempting through advertisements and letter writing to push for the legal right to dispense drugs. One such letter says: "There is a strong feeling that with national health on the horizon, the entire profession does not assume the role of family practitioner, the current services will be designated to other health care fields." So the proposal is that we become more like medical doctors because only medical doctors will survive.
Other see big opportunities in increased referrals from medical practitioners. Because recent nonpartisan research indicates chiropractic is superior to traditional medical approaches in helping low back pain, this thinking urges our profession to market itself as back pain specialists. Presumably we should pull in our horns and not tell anybody we believe chiropractic helps more than the back: that way, medical doctors will feel comfortable referring to us. As referrals from medical doctors to chiropractors increase, the theory goes, chiropractic's place in the health care spectrum will be secure.
How's that for irony! Only a few years after winning the Wilk antitrust suit, factions in our own profession want to compromise the identity we fought against all odds to preserve. Some want us to become medical doctors. Others wants us to become a sort of tolerated stepchild who doesn't threaten the well-to-do medical family. Well, there is another option. There is a better way.
Let me try to make a couple of things clear. For one, I do not mean to challenge either the value of pharmaceuticals or the practice of medicine. However, I am concerned that chiropractic, which is also of enormous value to humankind, is in danger of being redefined to merge with medicine. For another, I'm all for cooperation through referrals and other means, but to downplay or abandon our philosophy of how chiropractic works for the sake of expediency is to forsake our heritage and our mission.
Any discussion about changing the basic nature of what chiropractors do must take into account three things: the motives, the timing, and the long-term impact.
The principal motive in the proposals seem to be financial, and no ground is more treacherous than purely financial motivation. Has it occurred to would-be drug dispensers that chiropractors' liability and malpractice insurance likely would skyrocket? Has it occurred to the "back only" crowd that once the medical profession circumscribes us they can easily eliminate us by training their own spinal manipulators?
Dr. Louis Sportelli, in an open letter, makes an excellent point that the timing couldn't be worse for chiropractors to start dispensing drugs: "The entire health care system is moving toward a wellness paradigm -- less drugs, less surgery, more conservative approaches, more attention to lifestyle changes, and an entire shift in attitudes towards outcomes."
If such a wellness paradigm is on the way, then this also is a poor time to restrict what we could offer it. Helping the entire body -- not just the back -- heal itself is what chiropractic can bring to the party.
The long-term impact likely from reacting out of short-term expediency is the extinction of our profession. If we are destined for extinction, then let it happen because the science of chiropractic, the practice of chiropractic and the philosophy of chiropractic are found to be invalid and ineffective for the care of human ailments: let it not happen because of a desire for financial security or a comfortable public image, otherwise the human race is the ultimate loser.
So, what should we do when the lion roars?
First, instead of running in all directions, this is the time to close ranks, to stick together, to solidify toward the middle. The Mercy Guidelines will be enormously helpful in our acting consistently and unitedly. Our profession needs to assimilate them as quickly as possible.
Second, once it becomes clear where the danger is in health care reform, we should act together forcefully. If specific legislative proposals pose a threat, let's write our letters and make our calls to remove the threat. United we stand, divided we fall. We can have faith in representative government, especially if we know how to work within the system.
Third, let us give all possible support for research to provide scientific validation for what chiropractic does. With that evidence in hand, we are in the best possible position to deal with the health care reformers. Look, boys, here's what chiropractic can do, and see how little it costs!
My own view is that health care reform provides as many opportunities for our profession as it does threats, thanks to the emerging wellness paradigm Dr. Sportelli mentioned. The Mercy Guidelines already have been enthusiastically received by the Agency for Health Care Policy and Research, the federal unit that will have tremendous input into health reform measures. Boosts to chiropractic from the last session of Congress (HEAL loan increases, commissioning chiropractors in the military, etc.), demonstrate that our profession can conduct successful lobbying campaigns. And research here at Palmer College and elsewhere is adding to the support of chiropractic theory practically every month.
In short, we should stay on our toes, sniff the air, and be ready to move together. But let's not panic. Let's not scatter. Let's not take rash steps that would put us in further peril. The only thing we have to fear is ...
Donald P. Kern, D.C.
President, Palmer College of Chiropractic