Yes, I always go back to the Rx issue, because that (I believe) will be lightning rod for continued attacks on our Profession by you-know-who.

And since many of your comments appear to be similar to ones made by the Progressives, or Extended Pracitioners (specifically about subluxation), excuse me if I have mistakenly identified you as one of “them”. It IS possible that you could be interested in the topic, but have no strong strong desire to see it happen.

So, let me ask you: Are you in favor of DCs getting Rx privileges?

If so, why?

My opinion is that it’s a bad idea, but mainly because it will draw fire, and to a lesser extent because of the iatrogenic downside.

I thought this was interesting: “Concerning my opinion about clinical experience and expertise: you don’t seem to differ. You agree, but couch it as a conflict. In some senses, medicine has hamstrung us. In others, we have done it to ourselves and continue to do so.”

Tell me more. I became a DC in 1993, so the Wilk decision, and to a lesser extent the New Zealand Report, color my thinking about Organized Medicine and their long history against us.

I am curious how or why you feel “we” have contributed to the situation.

I’m not sure what you mean by this: “I differentiated those that think that the only thing a DC should do is detect and correct subluxation, and those who do differentially diagnose within their practice.”

We all learned pathology, and the logic of differential diagnosis, as a primary component of our education. Even so, the average DC does not usually use ICD codes to identify a patients primary complaints as diabetes, or cancer. I may treat a patient who has diabetes, but when I adjust their spine, it is because they are subluxated (or have a “manipulable lesion”, or whatever you choose to call it). Even if I inquire about their diet, and make some recommendations, I am not really “treating” them for diabetes, in the usual medical sense of the word… we have a more holistic approach.

“Us vs. them” aside, you stated that there is some literature out there (your words were: “every study and poll“), and all I am asking is that you share those with me.

I did NOT say I had “a visceral reaction to certain things being discussed“, I said that “I am viscerally against the idea of limited prescription rights” and clearly spelled out my reasons.

Finally, I want to thank you for participating in this discussion. We all stand to benefit from improving our understanding of each other.

But, that is part of the problem. DCs are obsessed with the issue… they see the pink elephant in the room, even when it’s not there.

To my knowledge… no one has suggested that DCs should just “have” Rx authority.

New Mexico has suggested a MS degree, on top of the DC degree… with hundreds of hours of clinical rotations AND supervised authority after that for a year.

Concerning my opinion about clinical experience and expertise: you don’t seem to differ. You agree, but couch it as a conflict.
In some senses, medicine has hamstrung us. In others, we have done it to ourselves and continue to do so.

And again… read what I wrote:

I never said anything about progressives and majorities.

I differentiated those that think that the only thing a DC should do is detect and correct subluxation, and those who do differentially diagnose within their practice.

Most DCs DO differentially diagnose, and all were trained to do so.

How is this a “progressive” issue?

I also said, which you just quoted, “The debate about “who is in the majority” still needs to be hashed out… every study and poll that tries to clarify the point is unabashedly dismissed by those who don’t agree.”

That is not a “my team vs. your team” statement… that is an acknowledgement that despite what everyone likes to think, every time data is presented, there is some group that cheers, and some group that jeers.

There have been polls… and some small studies… but, nothing concrete enough to end the debate of progressive vs. centrist vs. conservative vs. evangelical. That has been going on since the BJ and DD feuds. You can look at the Dynamic Chiropractic polls… they tend to be split down the middle.

I understand that you have a visceral reaction to certain things being discussed within the profession. Many do… the point is to get beyond the visceral responses and move toward educated ones.
It may end up that the educated response supports your fears and concerns, however… we need to get beyond that.

Thoughtfully written.

I agree that what happened in Texas was the “TMA attacking DCs for everything from diagnosing ANYTHING“, but by their own statements, it was MUA and needle EMG that got their ball rolling.

It’s no surprise they would try to use the antiquated terminology in our Practice Acts, but those laws initially adopted those terms (analyze vs. diagnose) BECAUSE of medical harassment, and as a way to distinguish the chiropractic approach from the medical approach. And, it worked.

Are we due to re-write those laws? Of course. And to do that, DCs will have to spend money, and focus their efforts on State Legislatures to make that happen.

I am viscerally against the idea of limited prescription rights because it’s the practice of medicine, AND because it’s not chiropractic. Worse yet, it is a distraction from strengthening State Practice Acts, and will become a lightning rod for more unnecessary battles with the AMA.

You even said: “I don’t believe many DCs have enough clinical exposure to MSK disorders or even adjusting real patients before graduation.” I beg to differ. Yes, we are trapped within out school clinics, and do not have access to the diversity of patients that enter hospitals daily because of how Medicine hamstrung us.

It’s not that our education isn’t excellent. We just just don’t have access to diversity. Hopefully that will change, if DCs ever get a chance to intern in Hospitals. It would make sense, and could save a LOT of money in the long run. See the following for WHY.

Pren Manga, in his Aug. 1993 report to the Ontario Ministry of Health stated:

If you want prescription rights, that is your right. I agree with your observation that: “The issue is that they (MDs or the AMA) can pursue groups that they feel don’t have appropriate training or scope… and therefore may be a risk to public health. ” I feel the same way about anyone taking weekend classes in manipulation.

It appears you are confused about what I asked you: You stated: “The debate about “who is in the majority” still needs to be hashed out… every study and poll that tries to clarify the point is unabashedly dismissed by those who don’t agree. ” THAT is what I asked citations for. Every Progressive likes to claim they are in the Majority. Prove it. Show me.

The issue wasn’t people trying to push the envelope, and subsequently instigating a response. It was the TMA attacking DCs for everything from diagnosing ANYTHING (including musculoskeletal disorders) to things like MUA and needle EMG using archaic language.

The challenges are coming, not because of some theoretical vanguard who “started providing needle EMGs, and now want prescription rights”… but, because we were providing services that were well within the established rights and scope within the state without changing archaic scope language.

The arguments given for not changing that language (from within the profession) are exactly the ones you are using… that we will, essentially, upset the AMA.

Our practice acts, nationally, are archaic. There are states which only list “x-ray” in terms of diagnostic imaging… and if an anti-chiropractic group wanted to try to restrict our ability to order advanced imaging, they would have legal standing to do so.

You keep bringing up the drug issue… even though this case (and my subsequent commentary) have nothing to do with it. I really don’t know why this extends to prescription rights… or even the assumption that the modern DC education is the same as it was 20 or more years ago.

I don’t know of any proposal that suggests that a DC should just “get” Rx authority without substantial additional training.
(As a side note, I had 120+ hours of pharmacology in my pre-doctoral training, and I still don’t believe that I should just “have” Rx authority. Then again, I don’t believe many DCs have enough clinical exposure to MSK disorders or even adjusting real patients before graduation… so I am a little more stringent than most.)

The problem is not that MDs don’t want anyone to have Rx authority… there are nearly a dozen license types that have Rx authority on some level or another, and even more that can execute standing orders. The issue is that they can pursue groups that they feel don’t have appropriate training or scope… and therefore may be a risk to public health.

This was not a “progressive” issue… this was an attack on the entire profession using archaic language within a practice act to attempt to disable the profession as a whole.
To suggest that MUA and electromyography was “progressive” would be like saying that having a cell phone and an email account was “newfangled.”

As far as asking me for studies… are you saying that you don’t believe that most DCs “diagnose”? You have a list of ICD9 codes on this website… I am confused why you would disagree with the assertion that the majority of the profession doesn’t just say “subluxation” and ignore relevant modern diagnostics.

You state:

That’s what I was asking you about…the name of those articles, and where they were published.

I agree, that this is a HUGE wake-up call. Because Organized Medicine has so effectively marginalized us, they didn’t agonize (too much at least) about our State laws. It almost bordered on a cease-fire, although we all know that the regular issuing of bogus “chiropractors cause strokes” articles puts that lie to the test. There has always been, and (probably) always will be a medical movement to crush our profession, through any means possible.

These individuals who started providing needle EMGs, and now want prescription rights are about to BURY US, because all HELL is going to break loose.

The discussion is NOT about whether DCs could or should do these things. State law prescribes what a DC can do, not the AMA. It’s immaterial whether it’s “philosophically pure” or not.

Although prescription “rights” may alienate a few “conservative” DCs, it will TOTALLY OUTRAGE AND EMBOLDEN the AMA and their State Lackeys. There’s the rub!!!

That is why I am against it.

A trained DC will be, neither any better, nor any worse than an MD, when they prescribe anti-inflammatory drugs.

The literature is pretty clear on this…BOTH of them are stupid for recommending a drug that has such abysmal side-effects and risks, like NSAIDs have. I’d be happy to provide citations to support that comment, if you aren’t already aware of them.

I’m also ashamed that any DC, who had (relatively) the same training as I got, would refer to themselves as “progressive” because they want the “right” to prescribe them.

What they are really hungry for is market share, and by so doing this, they will RAIN DOWN HELL on the rest of us, when the AMA finally comes a-calling.

My Grandpa would say that these individuals were “penny wise and pound foolish“.

Finally, the title of this article is tongue in cheek. It’s NEVER a victory to be dragged into Court, but the Progressives better grow some serious skin my friend, because their going to be spending a lot of time (and money) fighting more pointless battles. I strongly recommend they don’t bother calling me for contributions.

It isn’t as simple as trying to make it about a divide between traditional DCs an progressive DCs.

This has to do with forces outside of the chiropractic profession using our own wording to restrict and control chiropractors. It is incumbent on us to make changes to protect the profession as a whole proactively.

The idea that the statute didn’t give them permission speaks to the same point… and how nEMG was lost because of the bevel of the needle. MUA was lost because it was in a “surgical theatre”…

As you know, I am up to speed on a number of topics, including this one.

The debate about “who is in the majority” still needs to be hashed out… every study and poll that tries to clarify the point is unabashedly dismissed by those who don’t agree.

That being said, the majority of the profession DOES diagnose and treat their patients… not to the exclusion of the classical “subluxation”… but usually including it IN the list of clinical diagnoses. Is that really disputed?

When you say “Most of the profession does not”, where does that statistic come from? I’ve never seen that in my long crawl thru the literature.

You are right: Texas DCs have been restricted, but then again, their State statute never actually gave them the right to pierce skin to do needle EMG in the first place. So in some respects, they brought this upon themselves.

For those of you who dream of an expanded-practice future (and I seriously doubt they are any where near the majority), your best bet is to start with State legislators to rewrite (and expand) your Practice Act. Once that’s done, outsiders from minority groups can’t stop you.

Meanwhile, review the long list of previous articles on this topic if you are not fully up-to-speed on this topic.

Many excellent DCs were undercut by the move by the TMA… and the win (more accurately a “save”) only marginally restored DCs rights.