By James Winterstein, DC,
National University of Health Sciences
Recently, I had the privilege of testifying for the chiropractic physicians in New Mexico who currently have some prescriptive rights and wished to expand that scope to improve their ability to provide stronger, more complete primary care.
It should be clear that I was asked to appear in behalf of the chiropractic physicians there or I would not have been there. It is not my purpose, as president of National University of Health Sciences, to dictate the direction of the chiropractic profession, but to provide the education that is required by the profession.
In this instance, the request to provide advanced education in pharmacology came to the university several years ago, just as requests to provide education in acupuncture came to the university 41 years ago and requests to provide education in "over-the-counter" medications came from Florida some 20 years ago. Our institutional charter says that we will "provide education," which is what we have done in New Mexico, and which we intend to continue to do in New Mexico and elsewhere when asked.
Some members of the profession appeared before the New Mexico Senate Judiciary Committee and testified against the wishes of the New Mexico chiropractors – not as invited guests, but as intruders into state concerns. Some of the senators even received calls from out of the United States urging action against the wishes of the New Mexico DCs. I consider this kind of activity to be completely inappropriate and negative toward the profession. New Mexico DCs see a need that can be met with additional education and an expanded scope of practice. They, it appears, have a concern for the public, while their detractors have a fiercely held belief that the chiropractic profession must always remain what it was when formed by its originators.
What I heard from the detractors was not just negative, but actually derogatory toward the educational process of the New Mexico chiropractic physicians. Furthermore, what I heard was that the detractors are opposed to the concept that chiropractic physicians are educated to practice primary care, which according to Council on Chiropractic Education (CCE), is a clear requirement.
Is the Chiropractic Profession Determined Not to Progress?
I am disappointed that members of the chiropractic profession seem intent on interfering with their own colleagues, who wish to expand their education and their practice rights, based on the idea that "chiropractic must be what it has always been." Those who are opposed to the efforts of the New Mexico DCs suggest that if chiropractors have the right to use prescriptive substances, they will, like the osteopaths, become "quasi-allopaths," and in so doing, lose their identity as members of the chiropractic profession. In reality, however, I think that argument is specious.
Certainly the osteopathic profession is highly successful today and it continues to identify itself as "osteopathic medicine," not allopathic medicine. Despite the continually-heard derogatory comments made by those members of the chiropractic profession who suggest that "osteopathy" has gone the way of "allopathy," apparently the osteopathic profession does not see it that way. At the same time, osteopathic medicine has gained stature and social authority that far exceeds that of the profession in the 1950s, prior to its move toward the use of prescriptive rights.
I can think of no profession other than chiropractic medicine that is so determined not to progress. What I have seen is that other non-allopathic professions, such as osteopathic medicine, have taken steps to broaden their practice rights, and often this has occurred on a state level, without interference from other members of the same profession. Psychology is an example where some states have given the PhD practitioner some prescriptive rights. Optometry is another example that began with one state making changes and others eventually following suit. What I have not seen happen, as implied by those members of the chiropractic profession who resist change, is that either psychology or optometry has become a "quasi-allopathic" profession. Members of the general public still recognize members of those professions as what they are and have been.
The Needs of the Public
So, where does this leave us as we consider the question suggested by the title of this article? I have been part of the profession since 1964 when I enrolled at National. That covers a time span of 47 years, so I could hardly be considered a "novice" in the profession. During those years, one of the aspects of our profession that has bothered me most is that we constantly talk about ourselves and what "we" want. Even when we submit papers on questions of societal need, such as those submitted prior to the passage of the recent health care legislation, we talk about ourselves.
Is the real question about "chiropractic" or is it about what the society that we supposedly serve really needs? Is it about what society truly needs or about what we think society needs? Does society need to see a chiropractic physician weekly for the rest of one's life, as suggested by members of the profession who oppose expansion of scope? Or should we be concentrating on the real needs of the public? I think it is and should be the latter.
Perhaps if we asked ourselves how we could better serve the public, our profession could move beyond serving the 7-8 percent of the population we have served for the past 30 years or more. Perhaps if we sought to truly serve the needs of the public, our profession would be growing instead of shrinking, as evidenced by diminished student numbers in our chiropractic programs.
While some in our profession denigrate osteopathic medicine, perhaps we could take a page from its history and observe how much it has grown as a profession since the decision to change perspective on the practice of osteopathic medicine in the late 1960s. While some say osteopaths have stopped the practice of "manual medicine," the evidence suggests this is not true – the profession continues to research the effectiveness of its form of manual medicine. The point is that some osteopathic physicians practice more like allopaths and some practice more like chiropractors; but their goal is to serve the public as osteopathic physicians, not allopathic physicians.
As a profession, we should be primarily concerned with the needs of the public and how we as a health care discipline can best meet those needs. Some of the chiropractic physicians in New Mexico have learned by practice experience that they could better serve their patients with some use of a limited prescriptive formulary. They undertook additional education and have received the legal right to use a limited formulary.
Time to Take the Next Step
At the recent hearings on the proposed bill [H.R. 127] that would expand those rights, they lost the request, thanks primarily to negative testimony from members of the profession who do not wish to see our profession utilize any kind of prescriptive medicines. Those same people refuse to see that what was prescriptive a few years ago (Motrin, Naproxen, Nexium, Previcid and Prilosec among others) are now "over-the-counter" and anyone (with no training whatsoever) can recommend them. During the testimony, however, they made the case that chiropractors (as they called them) are not nearly educated enough to use even a limited formulary.This is a sad state of affairs, in my opinion. While Drs. Brimhall, Soltys and I were invited to testify for the chiropractic physicians in New Mexico, those who testified against the bill were not – at least by any recognized organization I am aware of, but chose to interfere in the practice of those physicians who wish to better serve their public, based on the premise that they must keep the chiropractic profes-sion pure! Again – for them, it is all about the profession – as they see it. They made light of the Dynamic Chiropractic surveys that were cited in favor of limited prescriptive rights, saying the survey only represented a "couple hundred doctors." While that statement was being made, I was looking at that specific survey, which was answered by 720 chiropractic physicians – not a "couple hundred." A more recent survey shows that the profession is almost evenly split on the subject.
It is past time for us to take the next step. We see patients every day who are on numerous medications – often conflicting and fre-quently overutilized – but because we do not have the clinical authority to prescribe, we cannot "unprescribe," nor can we prescribe thoughtfully from a more chiropractic perspective.
Nothing would keep a DC from practicing manipulation only – from limiting one's practice as one chooses; but with additional education, what good argument is there that the chiropractic physician should not be permitted to serve the public by the addition of a limited formulary? It is time to move into the future. Let's take the next step, whether it causes tiering of the profession or not. To stand still is to regress, and that is not acceptable.
Enjoy the second article in this series:
A Prescription for Professional Disaster