Articles by JCS

In Defense of Back Care

In Defense of Backache Care

 

by

 

JC Smith, MA, DC

 

Whenever I want to learn about objective straight chiropractic (OSC), I turn to “The Pivot Review “ newsletter written by Joseph B. Strauss, DC, FCSC. While other straight writers tend to the hyperbolic rhetoric and meta-physical, quasi-religious examples to make their points, such as The Chiropractic Journal or Today’s Chiropractic, Dr. Strauss has the ability to write in a logical and an non-inflammatory way, albeit still focused squarely on “straight” chiropractic. Indeed, his review is the equivalent to a new book in the New Testament of BJ’s ol’ time chiropractic.

 

The April 2000 edition contained his article titled, “Medicine’s Strategic Victory,” clearly illustrated the gap between mainstream chiropractic and the mindset of the OSC group. In this article, Dr. Strauss says:

“We have finally received the blessings of the medical fraternity. Of course, how many have had a practice member say that the doctor was endorsing that care for anything other than musculoskeletal problems let alone to enable the person’s inborn wisdom to be expressed more fully? The medical doctors do not even bring up the issue of the philosophical chiropractors or those who think they can cure everything (a misunderstanding of what we do).

“That is why an organization like the National Association of Chiropractic Medicine (NACM) has not grown. They see themselves as the medically rational approach to chiropractic. They would take a position acceptable to the doctors. Little did they realize that the rest of the profession would also take that position making them unnecessary. Chiropractic is manipulation for joint problems. Of course, anyone with a brain can see the unfolding of the rest of medicine’s strategy. Keep the chiropractors out of the HMOs. Develop rehabilitation centers, then teach the physical therapists to manipulate or do it themselves. If things continue as they are, the rehabs will be able to hire out-of-work chiropractors to manipulate for them.

“That is where we are today. We are there because that is where the majority of our profession, from the leadership, to the schools, to the practitioners in the field has chosen to be. Every time a chiropractor accepts a patient FOR a back problem, that misunderstanding is perpetuated and strengthened. Tell a lie long enough and people will start believing it. There are a few of us that are not into that model of chiropractic and unlike the rest are not willing to feed into it. Unless the majority of the profession agrees that they do not want and that they will not accept the role of a back doctor, things will only get worse.”[1]

 

I’m stunned when I read such comments that “every time a chiropractor accepts a patient FOR a back problem that misunderstanding is perpetuated…Tell a lie long enough and people will start believing it… Unless the majority of the profession agrees that they do not want and that they will not accept the role of a back doctor, things will only get worse.”

 

Excuse me, but what “lie” is that? That we can help patients with backaches? According to the head of OSC, it is now a sin for a chiropractor to accept a case for back pain because it fails to emphasize the Innate healing hyperbole. Is this convoluted thinking or what? This super-straight mindset illustrates the degree to which many young straight DCs have been conditioned by the super-straight hyperbolists who decry helping patients with the epidemic of back pain.  The belief that an adjustment alone will cure them of whatever ails them is far-fetched enough, but they are also taught not to discuss pain or symptoms for fear of not being “principled, subluxation-based, straight chiropractors.”

 

Their belief that treating backache is somehow beneath their practice is rather annoying, and their callous disregard for patients’ pain and suffering earmarks the height of insensitivity that plagues the super-straight mindset. Dr. Strauss mentioned in his newsletter one interesting “thot” that illustrates this point of callous disregard for patients’ suffering with back pain: “We need to confront people’s desires for chiropractic care gently and kindly but honestly and  directly.” In other words, if a patient wants to talk about their pain and suffering, tell him to stuff it because “subluxation-based” DCs don’t talk to their patients, and they certainly don’t listen to them about that mundane stuff!

 

Dr. Strauss also disagrees that straight chiropractors should be able to diagnosis patients’ conditions:

“Straight chiropractic has come to be not an alternative treatment for disease, but an alternative to the treatment of disease...Straight chiropractic does not address disease or its cause in any manner... Therefore, to perform tests associated with the diagnosis of disease processes would undermine that objective... To do these procedures is detrimental to the patient’s understanding of straight chiropractic and hence dangerous to their health... When it comes right down to it, diagnosis is just as foreign to straight chiropractic practice as is automobile repair.” [2]

 

Again, I’m stunned by these sentiments: “…dangerous to their health”  to attempt a differential diagnosis? How can getting the patient into the right doctor’s office be a danger? It would seem that to ignore a differential diagnosis and not to refer a case to the appropriate doctor would constitute a real danger. Also, I wonder if unsuspecting patients of “straight” chiropractors know what they’re getting themselves into. Do they realize they won’t be diagnosed whatsoever, or that their chiropractor’s diagnostic skill is equivalent to his skill in automobile repair? I doubt they would.

 

I guess this means if a severe LBP patient or whiplash victim enters the office of an OSC, he will be told that pain control and spinal rehab is not the objective of this particular DC.  Those who profess such “subluxation-based” beliefs must have never had a severe back attack themselves, otherwise they would not trivialize or condemn those DCs who appreciate spinal manipulation and rehab as a treatment for back pain.

 

Indeed, if DD Palmer himself had been a “principled, subluxation-based” DC, he would have never known Harvey Lillard was deaf because he would have never asked!

 

I can imagine an initial consultation between an Innatist, subluxation-based, so-called “principled” DC and a severe LBP patient:

“Hey, Doc, my low back is killing me. Can you help me?”

“I don’t want to hear about your pain. I don’t treat pain or symptoms. I only detect and correct vertebral subluxations to release the Innate healing power of your body to heal you of whatever ails you.”

“Yeah, fine, but can you help me with my back pain?”

“Didn’t you hear me? I’m a principled, objective, straight chiropractor and we don’t discuss pain or symptoms,” said the Innatist as he clamped his hands over his ears.

“How can you call yourself a chiropractor and not discuss my back pain?”

“Because I’m principled and I am only interested in detecting and correcting vertebral subluxations to release the Innate healing power in your body. So spare me the nonsense of listening to you talk about your aches and pains. I’m hear to focus on the force behind the matter of life itself—the nerve energy. This is my philosophy.”

“Will you please give me an adjustment for my low back pain?”

“Nope.”

“Will you give me a low back support so I can stand and walk without pain?”

“Nope.”

“Will you refer me to someone who will?”
“Nope. I don’t diagnose or refer anyone to anybody. That would be practicing medicine, and I only practice ‘principled’ chiropractic on patients.”

“Nope, you won’t on me,” says the disgruntled patient as he leaves.

 

As odd as it sounds, I daresay this type of conversation must happen daily in the offices of OSC who subscribe to this “subluxation-based” principle putting their policy-over-patients’ needs. And since most of the public understands that chiropractic can help this epidemic of back pain, this type of encounter must appear to be at the least a bait-and-switch situation where the patient and DC are at cross-purposes. And at its worst, this must come across as an insensitive, callous and cruel joke by a chiropractor apparently more interested in his “philosophy” than in helping sick patients get well. Just how many new patients enter a chiropractor’s office asking for their “inborn wisdom to be expressed more fully.” Few, if any.

 

Even if a severe LBP patient were to overcome all these warning signs of professional indifference, what could he expect for care from a principled, sub-based DC? Probably just an upper cervical adjustment since most OSC turn up their noses at full-spine methods, especially flexion tables and rehab. And he certainly wouldn’t get any anti-inflammatory therapy like electro-therapy or simple ice packs. Nor would he get a back support or anti-inflammatory herbal muscle relaxants or pain suppressants, nor would he get any back exercises or rehab. And, God forbid, he would not get any advice on weight loss, proper posture or the need for future care to avoid a relapse.

 

All he would get from this “principled” DC is a pop and a prayer to Innate.

 

Ironically, Dr. Strauss also states in a side-bar in his newsletter: “In the coming year, 93% of the American public will visit a McDonalds, 7-10% will visit a chiropractor. Either we need a better marketing program or the American public needs to take more interest in its health.”

 

Uh? Is this an understatement or what? Perhaps too many Americans have been turned-off to chiropractic due to insensitive treatment by “principled” DCs with their policy-over-people attitude. I can’t tell you how many patients have transferred to my office from a straight DC seeking more care than they’d gotten. “He didn’t even give me a back support,” is one complaint I hear all too often.

 

Perhaps those patients who received incomplete care to stabilize their spinal injuries were turned-off to this simplistic approach when their back pain relapsed. “He didn’t even suggest I do spinal exercises.” To me, that’s equivalent to a dentist who won’t recommend toothpaste.

 

Or the most recent complaint I hear from patients from straight Activator practices: “All I want is a real adjustment.” Apparently the attempt by the doc to convince the patient that Activator was “modern and gentle” didn’t offset their wish to feel better with joint-moving, traditional, hands-on spinal adjustments.

 

Perhaps they found no relevance to the doc’s “philosophy” and their needs. “I told him my low back still hurt, but he didn’t seem interested. He didn’t want to talk about my pain.” Reminds me of that old saying: “People don’t care how much you know until they know how much you care.” Instead of a “principled, subluxation-based” mindset, I prefer a “principled, patient-based” one where the patient’s needs are first and foremost, not the practitioner’s policy-over-people.

 

Indeed, perhaps Dr. Strauss’ statement illustrates the impact ol’ time BJ dogma and OSC has had upon the American public. Until we re-package our product to one that is more effective in dealing with patients’ real needs first, perhaps old marketing concepts won’t fly. Policy-over-people has never worked well as we saw in the old Soviet Union or in PPOs and HMOs nowadays.

 

In fact, would anyone go to any doctor who places a sign in the waiting room stating, “The doctor is very busy, so please do not talk to him. If you do want to speak, please schedule a consultation”? Would you hire a doctor who didn’t want to talk about your pain or suffering? Would you trust anyone who wouldn’t try to diagnosis your condition, or refer you to the proper type of doctor for help? Indeed, would you trust anyone who places policy-over-patients’ needs?


I believe the super-straight/ OSC/ Innatists have a real problem with patients and with the rest of us in the profession. While I appreciate their vitalistic emphasis on innate healing, I don’t appreciate them making a pseudo-religion out of it, nor do I appreciate their callous policy-over-patients mindset. And their anti-social behavior to stay separated from the mainstream body of chiropractic only adds to our problems.

 

Mr. George McAndrews remarked about the irony of “principled” chiropractic.

“Cute phrases like ‘Above-down, inside-out’ or  ‘The Big Idea,’ may be soul-stirring at chiropractic conclaves; they are meaningless to economic experts (or even to HMOs) who must deal with the real problems of health care costs. It is the demigods who fear real research and fear advances in real knowledge who threaten your philosophy and your profession. Fact has a way of squeezing myth. Sometimes what is credible is not true.

Beliefs die hard. Again, I believe that research can result in an explosion of need for the services of chiropractors. I believe that certain headaches, ulcers, respiratory problems, allergies, etc. may prove to be singularly responsive to correction of the so-called subluxation complex. It will be a real shame if the fringe elements and the demigods in the profession destroy any hope of survivability by putting chiropractic in a death grip while the American Chiropractic Association and other research oriented bodies [NCMIC, FCER] attempt to deal with the real problems of the 1990’s--research and active representation before government and third party payers.” (McAndrews George. Private communication. March 24, 1992)

 

Unfortunately, stating my objections or those of Mr. George McAndrews to the Innatists falls on deaf ears, just as my objections to the anti-social behavior of the Jehovah Witnesses does the same. They both revel in their exclusivity and separate standards. They chant their doomsday philosophy that, if their agenda isn’t followed, the end is near. And their leaders love this alienated attitude because it keeps them in the money. Unfortunately, any chain is only as strong as its weakest link. Perhaps this inherent weakness in chiropractic will possibly lead to our downfall if the press and legislators are dissuaded by their hyperbolic rhetoric and misrepresentation of our profession.

 

For examples, in the recent Military Health Services consideration of chiropractic into the Armed Forces and the Medicare HCFC effort, the WCA, a hybrid organization headed by the infamous Terry Rondberg of The Chiropractic Journal, through his lobbyist, Jim Albertine, sent Senator Strom Thurmond the “World Chiropractic Association’s White Paper on Chiropractic in the Military.”

 

This White Paper stated:

Chiropractic in the United States:
“There are two major schools of though in the chiropractic profession. The first considers chiropractic to be a limited medical specialty for the treatment of certain musculoskeletal disorders. Proponents of this position embrace a broad array of therapeutic interventions including manipulation and physical therapy modalities. This necessarily encroaches on the practice of medicine and physical therapy.

 

“The second school of thought is committed to positioning chiropractic as a separate and distinct discipline in the healing arts, which does not duplicate existing medical services. It is directed toward the correction of vertebral subluxations, which interfere with the function of the nerve system.

 

Chiropractic in Medicare:

“Chiropractic has been included as a Medicare benefit for over 25 years and provides for chiropractic services limited to manual correction of spinal subluxations. The Medicare benefit does not include physical therapy services. The only ‘condition’ covered is spinal manipulation.

 

“This position is consistent with the school of thought which positions chiropractic as a separate and distinct profession.”

 

To respond to Rondberg’s White Paper, first of all, there is just one major school of thought in chiropractic represented by the inclusive ACA, and there are a few minor schools of thought represented by the WCA, ICA and NACM, for examples. To imply that this minor group of Innatists is a major group is very misleading. Secondly, the military’s greatest need that chiropractic could help isn’t with some Innatist concept of restoring nerve function to let Innate heal whatever ails you, but their greatest need that chiropractic can help is with their epidemic of LBP that cripples 30% of their active personnel. Again, for some unknown reason, this White Paper fails to address this pressing need illustrating once again the super-straights’ problem with policy-over-patients.

 

In regard to this so-called White Paper (a White-Wash Paper would be more accurate), Rondberg again misrepresents our profession’s desire to have Medicare withdraw its stranglehold on our services. Rather than supporting a definition that would allow DCs to be paid for all their exams and services, this Paper suggest that “correction of spinal subluxations…is consistent with the school of thought which positions chiropractic as a separate and distinct profession.” I guess Rondberg is happy with us practitioners working with handcuffs and not getting paid for all that we do to help Medicare patients. (Just who’s side is this guy on, anyway?)

 

While the ACA lobbies the legislators to broaden our position to include all services within our legal scope, we find Rondberg and his WCA politicking against the ACA position. With colleagues like this, who needs enemies?

 

Nonetheless, Sen. Thurmond was not swayed by Rondberg’s effort to mislead him. Sen. Thurmond responded to this WCA White Paper by stating:

“It appears that the ACA continues to consolidate its representation of the chiropractic profession. It is helpful to those of us in Congress to have such consolidation so that any historical confusion resulting from what had been divided efforts will continue to be reduced.

“It would appear beneficial to the chiropractic profession if the ‘World Chiropractic Alliance’ could eventually meet the requirements of the World Federation of Chiropractic and perhaps become either a member organization of that body or otherwise find it advisable to incorporate the Alliance’s membership into the Federation. This, in my opinion, would go a long way in further reducing the previous confusion coming from what has been perceived as a divided profession, a factor that appears to be in decline.” [3]

 

I would have loved to seen Rondberg’s face when he read Sen. Thurmond’s suggestion that his WCA join the WFC, headed by Dr. Lou Sportelli, Rondberg’s long-time nemesis. Of course, knowing the hate-straights’ propensity for spiting our profession, I’m sure Rondberg has already cut off his nose to spite the ACA and WFC. And I’m sure Rondberg failed to tell his readership of Sen. Thurmond’s suggestion for the WCA to join the WFC.

 

Lastly, in defense of chiropractic care for good ol’ neck and backache is ironic in light of the fact that 95% of all DCs do exclusively that. I find it odd that we finally get our foot in the door of legitimacy by helping this massive epidemic of LBP, and some would just as much like to slam it shut, turning up their noses by saying, “we don’t do backaches.”

 

I know I’m biased as a victim of three serious spinal injuries, but to snub our noses at this is foolish and will only drive more patients away from us to the back surgeons. I suggest if the super-straights/Innatists don’t want these cases, please do refer them to me or my colleagues who are more than happy to care for back attack victims. But, I guess they couldn’t do that since they don’t talk to their patients about mundane issues like pain or suffering. Oh, well, I guess the super-straights could at least do the Money Hum and point them my direction!



[1] Strauss, JB. Medicine’s Strategic Victory. The Pivot Review, vol. 16, no. 3, pp. 4-5, April 2000.

[2] Strauss, Joseph B., The Pivot Review, vol. IX, no. 5, 1993.

[3] Private communication, Sen. Strom Thurmond letter to Mr. Jim Albertine, April 26, 2000.

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