October 2007

Is it already too late to save chiropractic?

by Dr. Terry A. Rondberg

For years, there have been warnings about the very real possibility that chiropractic, as we know it today, may cease to exist. We've seen it happen to other professions, notably osteopathy, which was subverted into a medical modality under the thumb of the medical and drug industries. Osteopathy, as it was practiced by healers who were offering an alternative to allopathic medicine, is gone.

We've been battling the same drift into medicine that the DOs did for years. So far, we have (for the most part but with notable exceptions) resisted the pressures to sacrifice our identity in an attempt to become part of the medical paradigm. We still have a solid core of dedicated chiropractors who want to remain doctors of chiropractic ‑‑ not doctors of chiropractic medicine.

And, believe me, the medical hierarchy (and those within our profession who want to join them) know that. They've tried for more than a century to tempt, prod and push us to follow the osteopaths into the medical pool, where all of us "little fish" can swim under the watchful eye of the MDs.

Now, they're attempting a new tactic. If they can win us over, they'll try to confine us to a small box and then make the box smaller and smaller until we're reduced to nothing and can't threaten them.

The box started out being neuromusculoskeletal conditions. Then it shrank to musculoskeletal condition. Then down to low back pain in adults. Now, thanks in great part to the Council on Chiropractic Guidelines & Practice Parameters (CCGPP), the box is being labeled "low back pain in some adults."

According to the CCGPP's latest chapter of its "best practices" document, there is only limited evidence to support chiropractic care as part of a prenatal health regimen in pregnant women or even to help relieve back pain in these women. The same goes for chiropractic care for children, even in cases of asthma, infantile colic, and otitis media. Forget back pain for older adults, too. According to the CCGPP, there is only limited evidence that chiropractic does any good for those patients.

Receiving the lowest ratings was any kind of care outside the pain treatment paradigm ‑‑ patients with other non‑musculoskeletal conditions or for health promotion and/or disease prevention.

Where does that leave you?

How many of your patients are children? Give them up ‑‑ CCGPP says there's no evidence you're doing them any good.

Say goodbye to your older patients as well. CCGPP shrugs off the "limited evidence" of chiropractic care's effectiveness in addressing chronic musculoskeletal or low back pain in older adults.

Do you ever offer adjustments based on the premise that having a subluxation‑free system will help improve general health and well being? STOP IT! According to the CCGPP, there is a lack of sufficient evidence to support such care.

When the insurance companies get hold of this report, they'll use it as a weapon against chiropractors and an excuse to reject claims. They do NOT have to pay for any unproven treatments and, according to the CCGPP, there is no proof that chiropractic care does any good at all! The only practices that received an "A" rating involved talking to patients about breast feeding, smoking and exercise!

And have no doubt about it, this document WILL be sent to insurance companies. The CCGPP has already contracted with the Work Loss Data Institute to publish and distribute the document.

It will also be used by lawyers to "prove" that DCs performed medically unnecessary services. It doesn't take much imagination to picture the courtroom scene.

You have been accused of malpractice because you adjusted a child suffering from chronic ear infections. You know from your personal and clinical experience that subluxation correction often relieves this condition.

You're familiar with the research studies such as the one involving 332 children, published in the Journal of Clinical Chiropractic Pediatrics, that concluded: "there is a strong correlation between the chiropractic adjustment and the resolution of otitis media for the children in this study." And the one in the JMPT in which "93% of all episodes improved, 75% in 10 days or fewer and 43% with only one or two treatments."

But, the opposing lawyer pulls out the CCGPP "Best Practices" guidelines and tells the court that those research results don't count because the newest document gives chiropractic for children with otitis media only a "C" rating, indicating that there is only "limited evidence" to show it does any good. Obviously, you provided an unproved "treatment" to the child and are guilty.

And I'm sure you can imagine what such a document will mean to medically oriented boards whose members have a record of harassing doctors who care for children, pregnant women, older people, and those who simply want to live healthier lives without drugs and surgery. You ‑‑ and your patients ‑‑ know chiropractic can be of great benefit, but if the board wants to stop you, they now have the weapon they need. After all, there is absolutely no significant evidence ‑‑ according to the CCGPP ‑‑ that chiropractic care can help any of these people. You risk losing your license or being censured if you follow the dictates of your conscience and the precepts of your profession by adjusting them.

What can you do to save your profession and your practice?

There's really just one thing. You have to confront your accusers with a more credible document to counter the one produced by the CCGPP. The only document that fits that bill is the Council on Chiropractic Practice's "Clinical Guideline: Vertebral Subluxation in Chiropractic Practice." First published in 1998, the CCP Guideline was revised in 2003 and is in the middle of a second revision.

The last revision process took nearly two years and involved more than 250 chiropractors, scientists, researchers, technique experts, lay people and others around the world. The revised guidelines included new recommendations dealing with maternity care, peer review, open adjusting rooms, heart rate variability, radiographic digitizing, record keeping, and patient privacy.

Unlike the CCGPP, the CCP took into account all research deemed valid. Prior to beginning the actual revision of the document, the CCP panel conducted an intensive review of current literature relating to guideline development and methodology. The panel was able to incorporate many of the new concepts and procedures into the process.

Unlike the Mercy Guidelines, the CCP guideline is included in the National Guideline Clearinghouse (NGC). The NGC is a comprehensive electronic database administered by the Agency for Policy and Health Care Research (AHCPR), which allows access to accepted guidelines from various health care disciplines. The Clearinghouse was developed in partnership with the American Medical Association (AMA) and the American Association of Health Plans (AAHP) to promote widespread access to guidelines.

To be accepted into the NGC, the CCP guideline had to meet a set of stringent inclusion criteria. Among these was the requirement that it produce documentation showing that a systematic literature search and review of existing scientific evidence published in peer reviewed journals was performed during the guideline development.

In court and in case of board complaints, the CCP Guidelines have proven their worth as valuable tools for validating chiropractic practices as well as care for the broadest possible range of people, including children and asymptomatic patients. Doctors have shown that they can present the CCP Guidelines and successfully counter anti‑chiropractic arguments based on the Mercy guidelines.

You'll need the CCP Guidelines to counter the CCGPP document as well.

But will the CCP Guidelines be there when you need them? That depends a great deal on you. Right now, the CCP is undergoing a thorough revision that will require massive research to locate and evaluate all existing literature regarding chiropractic care.

Thanks to the fact that the CCP relies almost totally on volunteer efforts from chiropractors around the world, it needs approximately $25,000 more to complete its revisions.

If that sounds like a lot, compare it to the CCGPP's 2006 budget of $444,000, which brings the total already spent for its activities to well over a million dollars.

We need you to donate NOW. Before the CCGPP finishes its document and gets it into the hands of the insurance industry. Before it's too late.

We need just 25 dedicated doctors to donate $1,000 each. Or 50 to donate $500. Or 100 to donate only $250. That's all it will take, but are there even that many doctors willing to put their money where their heart is ‑‑ in chiropractic?

We'll find out. I'll let you know in a month or two whether those 25, 50 or 100 doctors stepped forward in time to save their profession.

Be one of those doctors. Go to the CCP website at www.ccp‑guidelines.org, and make a donation online.

This is no idle warning when I say, our ‑‑ your ‑‑ future depends on it!