March 2005

You can change the world

by Dr. Matthew McCoy

A "movement." As a young child, that's what I remember chiropractic being called. Whether it was at a DE meeting, Renaissance seminar, philosophy night, the theme was the same.

There was something to this profession ‑‑ in fact it was bigger than a profession. We were told it was bigger than medicine, bigger than law, bigger than religion. The "movement" had momentum that was palpable. People became chiropractors to join a cause to change the world. Most had their lives changed through the power of the adjustment and wanted to do the same for others.

What happened? Chiropractic school enrollments are down, chiropractic is simply a career choice for most who enter it these days, the infighting within the profession is at an all‑time high, and the biggest chiropractic news of the day is the recent research study by ASHN that says we're cheaper for low back pain.

Duh.

Many of you have been to some big chiropractic gatherings around the country over the past few years: 500, 1000, 5000, even 10,000 in attendance. They have the feeling of a movement, but as a good friend told me after attending one of these, he knew how Christ must have felt in the marketplace. Cellulite removal? Is that part of the movement to save the world?

And everyone gets pumped up from the celebrities, the chiropractic motivators, yada, yada, yada ‑‑ but then what? Everyone goes home. Home to ASHN denials, home to neck pain, back pain, headaches and press releases about raking leaves, shoveling snow and tight pants. The passion subsides ‑ lasts about a week if you're lucky.

The sensible shoes and Sansibelt crowd has taken over the profession. It is so out of control that it would not be believable if the evidence were not staring you in the face. Doctors losing their licenses for telling their community that chiropractic may improve immune function, for saying that chiropractic improves human potential, or for offering care in a healing environment of openness and community.

And what does the majority of chiropractors do about it? Nothing. Absolutely nothing. "Thank you, sir. May I have another?" is the collective response from what was ‑‑ in the distant past ‑‑ a movement. We're afraid of speaking up and standing by our colleagues because we might be next. Because we know we're doing the same things. And one by one they pick us off.

Unless you've been in a cave for the past few months you've no doubt seen the images from the Ukraine: hundreds of thousands of people standing, marching, praying, and singing. In the cold, in the rain, daytime, and nighttime. Young and old. Government workers, police, military and ordinary citizens. United for a cause, for a movement.

What is happening in the Ukraine is certainly one of the most profound events of our generation and perhaps in history. The sleeping giant awoke. The people decided they weren't going to take it anymore. For weeks upon weeks, the masses gathered in the center of the city. On 24‑hour shifts, people erected a tent city, opened up their apartments to strangers, fed them and let them rest there so they could go out again the next day.

And they did this despite the fear and the threats and the danger. Their future hung in a delicate balance. The fear of the Kremlin, the threat of civil war, the danger of death, the poisoning of their leader.

What if the collective masses of our profession rose up? What if we took back our profession? What if we had a movement again?

Defining reality

Go ask a class of first‑year chiropractic students why they became chiropractors and you will find that the majority of them made a career decision. Gone are the days when most are there because of a personal life‑changing event that followed a chiropractic adjustment. The majority of a recent class of mine had never even been adjusted prior to entering chiropractic school.

Not long ago, I asked a prospective student why he had decided to attend osteopathic school instead of chiropractic college. "Why would I?," he answered. "I can become an osteopath and have a broader scope, work in hospitals, be respected and do the same thing a chiropractor does without all the headaches."

Where does this leave us? Where it always does: research. If we really want a level playing field, we need to compete using new tactics and strategies. Gone are the days when we could rest on the fact that patients wanted what we had to offer. Truth be told, the number of patients visiting chiropractors hasn't really changed in 30 years and now ‑‑ as evidenced by a recent District Court decision ‑‑ they can supposedly get what we have to offer from a host of providers.

We need to make a concerted effort to research the subluxation and its epidemiology through long‑term longitudinal outcome studies that show the negative health outcomes we associate with it actually exist and the positive health outcomes we associate with its reduction actually exist.

At the same time we need to demonstrate that we are better at finding them and correcting them than any other type of provider. We need to own the basic and clinical science related to subluxation and be light years ahead of the competition. We need to show the clinical meaningfulness of subluxation.

This is what RCS ‑‑ Research & Clinical Science ‑‑ is doing.

If we don't, the marketplace will continue to erode the number of new applicants to chiropractic programs. The number of practicing chiropractors will peak and begin to regress. There won't be enough practitioners to support a robust and thriving profession, which will lead to further encroachment on our rights as chiropractors.

Other practitioners will continue to step in and offer manipulation as a procedural option to those seeking it for musculoskeletal problems. Our profession will then be a small faction of practitioners with two or three schools struggling to keep a marginal supply in the pipeline. Don't like this prediction? Show me the alternatives!

All about the Benjamins

Look at the numbers. American drug companies invested $33 billion on drug patent protection alone last year. The government (that's you and me) spends almost $30 billion a year on basic drug research at National Institutes of Health laboratories and at universities.

Through programs like Medicare and agencies like the Veterans Administration, spending for prescription drugs is growing more than 10 percent a year and will hit $46 billion in 2004. That's almost one‑fourth of the nation's total spending just for these drugs, according to the Department of Health and Human Services.

The expansion of Medicare's drug coverage for the baby boomers will add more than $50 billion a year to the bill, on average, over the next decade. And the nation's bill for prescription drugs is forecast to reach $520 billion a year by 2013.

Yet, according to Professor Aidan Hollis, an assistant professor of economics at the University of Calgary in Alberta, "The pharmaceutical market is probably the worst‑functioning market that there is." $520 billion a year and they aren't even functioning well. Imagine if they got their act together.

David and Goliath

According to American Chiropractic Association President Donald Krippendorf, "The Trigon lawsuit may be over, but that is hardly the end of the story. We're sending a loud and clear signal to the insurance industry that when it comes to abusive practices that discriminate against chiropractic the battle is just beginning. Insurance organizations must understand that there will be a price to pay if they don't reform their ways."

With all due respect to Dr. Krippendorf, the profession has already scraped up $7 million to lose the Trigon and HCFA suit. The medical‑pharmaceutical‑industrial complex probably spends that much money each day on toilet paper.

David and Goliath is a nice story, but let's remember how David won. We're not as strong financially. The American public spends $520 billion on drugs while the entire chiropractic profession is lucky if brings in much more than $5 billion a year. This is why we can't beat them financially or legally. We need to beat them in outcomes as demonstrated through clinical research, and have an expert marketing plan to promote those results.

While we all seem pretty sure we could do this, we have yet to establish the infrastructure needed for such a task. Our colleges are busy trying to recruit students; research is not considered a revenue generator and is given a low priority. If you need proof, just ask any chiropractic college research director what the school's research budget is.

The research that has been done is being used by a few in the profession to set up managed care plans that limit chiropractic to 6‑12 visits for musculoskeletal conditions (adults only, no children need apply).

A better approach

I believe we can beat the medical‑pharmaceutical industry in outcomes. Improved quality of life, enhanced function, fewer drugs, less surgery ‑‑ coupled with a reduction of vertebral subluxation.

The short‑ and intermediate‑term answer is not competing with them financially. We must demonstrate our success in objectively reducing vertebral subluxations and the outcomes that result.

The long‑term results will take care of the rest of the needed paradigm shift. That shift is 25 to 100 years from now, when the economy can no longer handle the strain of a trillion dollar entitlement.

What we do right now determines who "owns" it later. Do you care?

Contact RCS today and join the movement.

(Matthew McCoy, DC, is the Vice‑President of Research & Clinical Science (RCS), a private sector research program exploring issues of subluxation correction and chiropractic care as they relate to health and wellness. He is one of the founding members of the Council on Chiropractic Practice (CCP), 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, Director of Research at Life University, 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 about RCS, visit www.rcsprogram.com)