Teach Them the Value of Chiropractic
Dear Editor:
Wrong, wrong, wrong. I can't say it any clearer than that. Mr. Petersen, yours is one of my favorite columns when I read DC each month.
I have been a chiropractic patient, son to a DC and second-generation chiropractor over the better part of 38 years. I truly believe I have this one figured out. I also know that as a profession we have been taking this particular issue in the wrong direction. This really comes down to the fact that our separateness from the medical profession has become a large part of our inability to grow.
Applause and accolades to Wilk, et al., for the good fight, but if you really take a good look at the famous AMA lawsuit, what you'll find is that Judge Susan Getzendanner did not order the medical profession (AMA) to start referring to chiropractors, but merely to stop boycotting them. Chiropractors raised their hands in victory but the lawsuit really did nothing to increase or stimulate medical referrals. Physicians and the AMA could no longer slander chiropractic, but they also had an out to choose to continually not refer while keeping their opinions to themselves. In fact, the AMA has never, ever taken a meeting with the ACA or any other chiropractic group. Surprised? Not me.
In that lies the real problem. The true reason medical doctors do not refer patients to chiropractors is that chiropractic is not taught in the majority of medical schools as a viable treatment protocol or method to use with musculoskeletal cases (as is physical therapy and referrals to specialists). When the newly minted physicians come into practice, are we to believe that just because more patients are using CAM therapies, they are going to start referring the majority of their back pain cases to chiropractors, much to the antithesis of their older practice partners? I think not.
Oh sure, MDs may throw us a "bone" here and there, but I have generally found in these cases it is because the patient first asked for chiropractic, not because the MD suggested it. There is a difference between the two. Over a three-year period, I sent numerous mailers to more than 40 family physicians, spent thousands of dollars and hours of time visiting doctor's offices with catered food, and even invited MDs to come to my office. Very few takers ... except for the food and the kind handshake after.
I am not discouraging working the MDs, Mr. Petersen. It's just that we need to realize there are very few chiropractors out there with a five-week waiting list for new patients like the orthopedists or neurologists. It's not because what we do is inferior; our separateness from the AMA and what medical college teaches both in philosophy and practice as it relates to the spine has kept us separate.
If we ever think that all the chiropractic research studies and patient satisfaction surveys will change the vast majority of medical teachings and referral patterns, then we as a profession are guilty of headis buriedis sandis syndrome. Enuf said.
The way I see it, we have three choices:
- Chiropractic joins the medical profession, but in a way that keeps our philosophy and practice separate when it comes to the care of the spine. In this way, physicians would be more likely to endorse chiropractic to their patients and we would see a greater jump in volume.
- Chiropractors stay separate as a profession, but fight every time a doctor won't give a patient a referral. This would also include filing complaints to the health insurance companies when a physician won't refer a patient because they "don't believe in chiropractic." The charge would be professional discrimination; it has worked for me here in Virginia. However, it also promotes very bad blood.
- Take the next 15 years of practice to buy fancy lunches, send pretty patient reports, design and wow physicians with facts and figures on chiropractic, but eventually have them only refer some patients because they will revert back to their own standards of care for musculoskeletal cases, which unfortunately doesn't include chiropractic as a mainstream source of referral.
Let's be positive for our profession, but still call the situation of medical referrals what it is. Our separateness is wonderful for our definition, philosophy and care, but when medicine runs the show with direction-of-patient-care paths and setting parameters for insurance companies and their payments, we have little leverage if we are not included. You think we should take a tip from the drug companies? OK, let's start by emulating them by having our names in their textbooks while doctors are still students.
Stephen Ambrose, DC
Richmond, Virginia
We Have to Bridge the Gap Ourselves
Dear Editor:
Your article was very interesting to me since I am employed by a major medical health care company in Washington state. My wife and I are the only chiropractors employed by the group, which consists of MDs, DOs, nurse practitioners and various specialties and subspecialties that represent the majority of our referrals.
I agree with all that you said in the article. I believe there are a couple reasons for the lack of referrals from primary care to our profession. I tell my patients that the struggle for the chiropractic profession was due to the AMA, but as we have advanced through research, we have become recognized for specific conditions.
I believe there have been great improvements with medical and traditional medicine recognizing our profession and utilizing it; otherwise, I wouldn't be where I am now. The major obstacle I see for the chiropractic profession is chiropractors. It goes back to the beginning and the never-ending debate on what the profession is. If we can't agree on what the chiropractic profession is, how can we sell it to others?
As you said in the article, if we want the profession to be recognized by traditional health care, we have to be the ones to bridge the gap ourselves. The challenge is that we all have to agree on the product we're selling and representing.
Robert Stalder, DC
Tacoma, Washington
| Editor's note: The following letters to the editor are in response to Dr. David Seaman's two-part series on the "curse of chiropractic." Part one, "Subluxation Issues: The 'Curse of Chiropractic' According to R.W. Stephenson" appeared in the Sept. 1, 2006 issue; part two, "The Genesis of the 'Curse of Chiropractic'" appeared in the Sept. 14 issue. |
The Importance of Subluxation Education
Dear Editor:
I do not believe Dr. David Seaman has provided "powerful ammunition to stop" chiropractors from promoting the vitalistic philosophy of subluxation care. The subluxaton is well-documented in Leach's text and other sources. None of us can argue with basic physiology. Dr. Seaman himself writes about the ramifications of subluxations, namely inflammation, as well as various negative outcomes of joint dysfunction.
From my reading of Dr. Seaman's article, he has no disagreement with innate intelligence or the mental impulse, either. I too understand Stephenson's assertion that the subluxation cannot block the mental impulse. However, it is time to discuss the quality of the mental impulse. Despite modern studies of anatomy, physiology and neurology, the quality of the mental impulse is, perhaps, still hypothesized. However, chiropractors witness daily functional impairment and poor health due to impaired mental impulses. Mental impulses start somewhere and end somewhere. They are also affected by what happens along the way.
Let's clear up this matter with the latest research in biophysics and psychoneuroimmunology. We still have a great deal to understand about communication between the brain and spinal system, but continued research only reinforces the importance of subluxation education inside and outside of our profession. I hope the differing chiropractic camps keep talking, because we all know chiropractic works. I fear we do not respect the simplicity chiropractic provides. Dealing with a society in poor health is much more complicated.
Lisa Ann Homic, MEd, DC
Auburn, New York
Many in Our Profession Have a Little Thinking to Do
Dear Editor:
In Dr. Seaman's recent article, he reiterates Stephenson's point, but goes a bit off course.1 In reality, Stephenson himself was merely reiterating D.D. Palmer's statement, "In disease, mental impulses are not impeded, hindered, stopped or cut off - they are modified."2 Is modification of a mental impulse interference? Of course.
Perhaps an analogy will help make this clear. As the reader reads this letter, the matter is the paper and ink. Light is reflected into the eyes of the reader. Although the exact nature of light is in question, we will state for our purposes that it is a vibration of matter. The vibration is transmitted to the brain. The brain receives the vibration and if intelligence is present, understanding is gained. The understanding is part of the mental realm and is not physical.
If water is dripped onto the paper and the ink runs, there could be interference with the transmission of the message. The thought of the writer is not altered. The understanding of the reader is altered because of interference with transmission. The light reflected from the page was not stopped or dammed back. It was modified. So, we see that understanding, part of the immaterial realm, was altered by modification or interference in transmission occurring in the material realm.
To further assist Dr. Seaman's understanding, I ask him to read an additional 21 pages of Stephenson's text. On page 294, he will find Stephenson's favorite theory: "The mental impulse is not an energy at all. It is a message." On page 295, he will find, "There can be Interference with the Transmission of Innate Forces."3
As it turns out, Dr. Seaman's article does not point out "powerful ammunition to stop those who advance the notion of chiropractic philosophy." It merely points out that many in our profession, on both sides of the philosophical debate, have a little thinking to do.
References
- Seaman D. "Subluxation Issues: The 'Curse of Chiropractic' According to R.W. Stephenson." Dynamic Chiropractic, Sept. 1, 2006. www.chiroweb.com/archives/24/18/16.html.
- Palmer DD. The Science, Art and Philosophy of Chiropractic. Portland: Portland Printing House Company; 1910, page 57.
- Stephenson RW. Chiropractic Textbook. Davenport: PSC; 1927.
Robert Clyde Affolter, DC
Post-Graduate Faculty
Sherman College of Straight Chiropractic
Bellingham, Washington
"The Less I Do to My Patients, the More I Do for Them"
Dear Editor:
Since D.D. discovered chiropractic in 1895, many people have attempted to explain how chiropractic works through philosophy and science. The ones who attempt to philosophically explain how chiropractic works are going out on a limb. On one hand, later science could disprove their "foundational Thots," while on the other hand, it could be an excellent starting point for funding good research.
Yes, many of the old-timers were simply guessing at how chiropractic worked, but I do believe that they, for the most part, had "the big idea." Without going into a lot of detail, I think the heart of the big idea is that an optimal structure equals optimal function.
Innate intelligence is a self-evident truth. No one is going to argue with anybody that the body heals itself. With a little educated intelligence, one would realize that the purpose of the spine is to protect the spinal cord. Spinal imbalance would cause a neurological imbalance in the CNS and disease would be the effect. Our job is to correct the imbalance.
Why can't chiropractic just move on with it? It seems that most of our profession has taken alternative roads (such as nutrition, acupuncture, massage, ultrasound, etc.) and has moved away from focusing on correcting spinal imbalance/subluxation. There are also many chiropractors who spend too high a percentage of their time discussing philosophically how chiropractic works. By endlessly discussing how immaterial things work, they attempt to make it material and somehow "grasp" it better. But that belittles (as opposed to magnifies) innate/inborn wisdom - something that is so huge and that we'll never be able to fully grasp (another self-evident truth). In his last article, Dr. Seaman said, "We now know that subtle misalignments in the spine have no clinical consequences. We also know that they are not corrected after adjustments, even though symptomatic and diagnostic indicators improve."
This position (which is false and not even an opinion), along with those chiropractors who spend too much time philosophizing and not enough time advancing the science of chiropractic are precisely why I tell others in the lay community that I am a spinal care practitioner and not a chiropractor. This is simply because the lay public is just as confused about what chiropractors should be doing with their time as we are. I don't want to have to explain to everyone I meet how I am different. I just say that I am different.
Humbly, I regret the fact that so many of us have fallen away from the big idea. If we get the big idea, everything else should follow. If we have an innate brain and educated brain and consciously realize the self-evident truth that we have an inborn wisdom, then why can't we spend our time and money and research and article space on advancing the science of chiropractic?
Despite Dr. Seaman's claim, NUCCA (the National Upper Cervical Chiropractic Association), for the past 40 years, has repetitively and measurably proven that as little as 1 mm or 3/4 degree of lateral movement of the atlas along the occipital condyles is enough to trigger the neurological component and cause dis-ease in the body. NUCCRA (NUCCA's affiliate research association) even has documentation supporting that there is a direct correlation between the percentage correction of the atlas subluxation complex (based on X-rays taken minutes after the adjustment) and symptomatic improvement. You can learn more about NUCCA at www.nucca.org.
The science of chiropractic is what kept us on the map for many years. We will not and cannot advance (in popularity or politically) until we get on the same page scientifically. I am not changing, stubborn as I am. I know that the less I do to my patients the more I do for them because (of course) it is their own body that does the healing. The key is, my work has to be the epitome of specificity and it must be scientifically based. Who's with me?
James Pietrek, DC
San Diego, California