December 2004

A failure of imagination

by Dr. Matthew McCoy

I don't know if you have seen the new television series "Medical Investigation," but as you can imagine, sexy, intelligent medical doctors who spend their time selflessly protecting us from potentially new and strange medical epidemics dominate it.

If you have read the book "The Coming Plague" then you know that the show isn't the reality of germ chasing that it makes itself out to be. Nevertheless, what does this have to do with chiropractic and subluxation?

Imagine that everyday the public health authorities are monitoring the entire world for outbreaks of this or that disease, surveillance is in place to detect new and emerging threats to public health and studies are underway to determine the global burden of various diseases that impact societies everywhere.

Do you think subluxation is on their list? Talk to chiropractors in New York, or in any part of the country for that matter, and they will tell you that on and about September 11 there was an increase in emotionally‑related subluxations ‑‑ no doubt tied to the stress and uncertainty of the events of that day. But you know what? It's only anecdotal. Our profession does not have a team of scientists sitting in a laboratory observing blips on graphs that would indicate an increase in reporting of vertebral subluxation throughout the country on or about September 11.

The reason we don't have this ability is because of a failure of imagination. As you might be aware, the 9/11 Commission chastised the American government for "a failure of imagination" that led to the eventual tragic events on September 11. They didn't just blame Bush, or Clinton, or the CIA or the FBI ‑‑ it was everyone's fault. As a nation we failed to imagine that the era we now find ourselves in could ever happen. Likewise, our profession finds itself on the brink of its own tragedy.

The health care system is in a crisis. Recent literature shows that the number of people being killed by organized medicine is approaching a million every year ‑‑ and these are just the people we know about.

Our government recently passed a $500 billion prescription drug benefit as a solution to the baby boomers' up‑and‑coming health problems. Corporations cite the rising cost of providing health care benefits as a reason for not hiring new workers.

Health care plans are now saying they will not be able to afford the cost of implementing the government's plan to provide health care to more rural areas.

And just what has the chiropractic profession been up to? We're trying to "find" ourselves through an identity project and asking outsiders what we should "be" to market ourselves better.

Some groups in the profession are sending out press releases on how good chiropractic is for back pain, be careful raking those leaves this fall and there is no "real evidence" that chiropractic has a positive effect on immunity. How pathetic can we be?

Our schools are in financial crisis. Our regulatory boards are taking away chiropractors' licenses for telling their patients that chiropractic has a positive effect on immunity, vitality and human potential.

All but a small minority of practitioners are financially well off as a result of their work as chiropractors.

And we have less than 70 full‑time researchers while the drug company Pfizer has 12,500! Kaiser Permanente recently launched a $40 million advertising campaign aimed at prevention, wellness and mind/body health including the component of spirituality. Their tag line is: Thrive.

The 60,000 plus chiropractors in this profession are all working hard, clearing the brush in the jungle on a daily basis ‑‑ the problem is that many are in the wrong jungle. I got to thinking about some of the things we need to do to educate the 77 million baby boomers who think they need free drugs to increase their vitality as they advance into their sunset years.

I came up with the following list; it's just a list right now and no doubt needs much fleshing out.

*** Provide chiropractors with the tools to provide a clinically driven, variable length of care format in which the frequency and duration of care is determined by each individual patient's progress toward meeting measurable objectives, set in individualized care plans and identified during individual assessment

*** Provide a uniform chiropractic care evaluation and reporting system

*** Objectively quantify the nature and degree of subluxation in patients

*** Provide comparative analysis of technique and practitioner results

*** Safeguard the unique language and descriptive terminology of the chiropractic profession

*** Utilize the unique assessment and analytical procedures of each technique to record findings and response to care

*** Extract a clear and consistent picture of each patient's health status and changes under care

*** Provide a common measurement standard easily understood by patients, third parties and other health care providers

*** Provide easy comparison of clinical findings across disciplines

*** Provide a common numerically based assessment system

*** Develop and facilitate the adoption of a universal language for recording the assessment and care of patients undergoing subluxation‑centered chiropractic care

*** Provide objective evidence of technique and practitioner‑specific efficacy

*** Provide a benchmark by which the necessity, quality and efficacy of chiropractic care is judged

*** Raise the profession above common manipulation into the true science of vertebral adjustment with specificity of measurement

*** Organize and categorize the body of knowledge regarding the application of chiropractic science

*** Characterize the subluxation in quantifiable and qualifiable terms using a language of numbers, health outcomes measurement and preservation of the chiropractic principle

*** Elucidate the subluxation through basic and applied science

*** Provide quantitative, objective analysis of health outcomes from chiropractic care

*** Research to validate the "gold‑standard" for subluxation‑centered wellness care.

Imagine for a moment that we utilized our resources to demonstrate the global burden of vertebral subluxation on our societies. Instead our resources are being used to garner larger insurance reimbursements for using moist heat, to position ourselves as worthy of an MD's referral, or to further study the effects of chiropractic on back pain, neck pain and headaches.

The Supreme Court has turned us down and there is no one left to sue. Do you believe that vertebral subluxation is an epidemic? Prove it.

The means exist ‑‑ the question is, does the desire and determination?

Our leadership failed to imagine that the principles of care our great profession is based on do not belong to us ‑‑ they belong to humanity. The profession that shepherds those principles of care, elucidates them and is able to apply that care best to a suffering humanity is the profession that will earn the right to continue to provide it. Will it be us?

(Dr. Matthew McCoy is one of the founding members of the Council on Chiropractic Practice, and has been instrumental in the development of the most widely accepted set of chiropractic guidelines. He's also editor of the Journal of Vertebral Subluxation Research and has extensive practice, research and educational experience. As chairman of the Council on Chiropractic Advocacy, he helps doctors of chiropractic facing board complaints, lawsuits, or other challenges. For more information, visit the JVSR website at www.jvsr.com or e‑mail Dr. McCoy at editor@jvsr.com.)