Articles by JCS
Is Chiropractic Politically Correct?
JC Smith, DC
Time has changed the public's consciousness on many sensitive issues. Attitudes about sexism, racism, equality and freedom of choice have changed greatly during the last few decades. No longer can jokes make fun of minorities, women or homosexuals without being considered politically incorrect. What had been considered funny years ago is now considered less than tasteful--even "blonde" jokes are frowned upon in many circles (What do you call a smart blonde? A golden retriever.).
Unfortunately for the chiropractic profession, the public's consciousness about insensitive remarks seems to have drawn the line short of our profession's position. Apparently the public hasn't been given enough "awareness" about chiropractic's plight to garner the same reaction. In many circles, bashing chiropractors is still considered politically correct, especially in the medical world. (How many DCs does it take to screw in a light bulb? Just one, but it takes 35 visits.).
For over a century now, political medicine has conducted illegal, slanderous and effective anti-chiropractic programs aimed at ruining our profession's image and competitiveness in the health care marketplace. For decades since our inception, political medicine made chiropractic care to be an "illegal" profession, declaring we were practicing medicine without a license. Thousands of courageous chiropractors went to jail and paid heavy fines as a result of this witch-hunt campaign. When the initial scope of practice laws were passed in the 1920s by individual state governments, much of this unholy persecution ended.
When political medicine could no longer make our profession appear "illegal," their tactic change to make chiropractic appear "taboo." Ethical medical doctors who referred to chiropractors were threatened with loss of licensure. Medical schools taught their impressionable students that chiropractors were "rabid dogs" who needed to be contained. Patients were threatened with abandonment by immoral MDs if they also used "quacks" in their health care. In fact, the early days of chiropractic was certainly "risky" business for everyone involved.
If making chiropractic appear "taboo" didn't work, political medicine's next tactic was to make our care appear "dangerous." Embellished scare stories about chiropractors "breaking necks" worked to scare too many naive patients. Even to this day I occasionally hear frightened patients tell me of their MD's "voodoo" diagnosis-- "If you don't have my surgery, you'll get worse. And if you go to a chiropractor, he'll paralyze you." Forget about the real truth as to iatrogenic problems caused by spinal manipulation or back surgery, the distorted opinions foaming from the mouths of medical bigots are most often thought of as facts coming from the mouth of Marcus Welby himself. And we wonder why patients are more often than not terrified of being adjusted?
If rendering chiropractic "taboo" or "dangerous" didn't work to deter chiropractic's growth, now political medicine's tactic rests with "managed" care. Of course, managed care is equivalent to saying monopoly capitalism. Not only do patients generally lose access to chiropractic due to the infamous medical gatekeepers who patrol patients like armed guards in a POW camp to prevent anyone from using our services, managed care systematically denies patients their basic American right of freedom of choice in regard to their own body.
"Managed" care has become the excuse of political medicine to deny care to patients and their right to enjoy chiropractic care. For the sake of cost-containment, the leaders of managed care have been able to convince politicians that cost reductions will only occur with a restriction of choice. Forget about the huge numbers of unnecessary exams, hospital stays and expensive surgeries that have escalated the cost of sickness care which the MDs routinely perform. Apparently the medical establishment has eyes to cut services mainly for the non-MD treatments which the public enjoys and not their own. And leading this charge are those biased insurance companies who have convinced the public with misleading advertisements and our politicians with hefty PAC contributions that this basic trade-off -- lowered premiums for no choice -- is politically correct.
Apparently political medicine has forgotten about the research and guidelines set by the Agency for Health Care Policy and Research in their attempt to lower health care costs. By pulling its political strings, political medicine had the AHCPR's mission reduced from setting guidelines that, if implemented, would have severely curtail many medical procedures that were clinically ineffective as well as cost-ineffective. As example, AHCPR's 14th guideline on Acute Low Back Pain in Adults in its Patient Guide mentioned that only one in 100 back surgeries is effective; that only one in 200 patients require expensive testing with MRI and CT scans; and that spinal manipulation is the recommended choice of treatment for the vast majority of these low back cases, yet political medicine and managed care organizations have turned a deaf ear to this guideline.
Despite this two-year study of 4,000 articles from the Library of Congress by a 23 member expert panel, headed by an orthopedic surgeon, which basically concluded that chiropractic care was IN and back surgeries were OUT, remarkably nothing has changed. Actually, more patients than ever are being railroaded into unnecessary back surgeries by a medical system more geared to profit than to do the right thing and refer to a chiropractor.
As well, the recent Republican revamping of Medicare by Rep. Newt Gingrich also snubbed chiropractic's expansion to cover all services rendered by a DC. This closed-door decision was particularly galling in light of the fact that Newt had applauded chiropractic's effectiveness with his own wife's low back condition. Yet, when the rubber hit the road behind closed doors with political medicine, chiropractic again got the political shaft. Incredulously, only a few weeks later, Newt's staff had the audacity to phone my office asking for a $400 donation, in return they would send me a replica of his official gavel. Not only did I tell his staff person that I didn't appreciate Newt and the Republican party shafting chiropractic in the Medicare dealings, but I also suggested a very dark place where Newt could stick his gavel. Apparently to Newt, chiropractic is politically correct when we give him donations, but we remain out of the loop when it comes to open and fair competition with his AMA Republican cronies.
Perhaps the most startling example of being out of the loop is chiropractic's relative obscurity within Worker's Compensation. Despite the fact that spinal injuries are the number one work injury; despite the Manga Report which conclusively stated that spinal manipulative therapy is safer, cheaper and more effective than medical procedures; and despite the fact that the AHCPR guideline on acute low back pain recommends SMT as the preferred initial treatment, most Worker's Compensation insurance companies frown upon our care. Despite the law which allows for our care, it has become virtually impossible for these patients to get into our offices due to medical gatekeepers and claims adjusters who refuse to refer. Their bias is painfully obvious when they prefer these patients to be railroaded onto the medical boxcar that eventually ends with back surgery instead of using safer, cheaper and more effective chiropractic care.
So, is chiropractic politically correct? Emphatically not! We remain on the fringe of many circles--insurance, hospitals, Worker's Compensation, and most of all, we remain on the fringe of the political system. Forget about the research which we hoped would convince these people. The research has been done, the debate is over, chiropractic clearly won, yet we remain still on the outside looking in. I imagine until the ACA can match the AMA in terms of political contributions, until we can match the many medical television shows which maintain the Marcus Welby image of medical doctors while news shows embarrass our profession with anecdotal scare stories (or the Money Hum), until we plant DCs on the board of insurance companies to represent our obvious benefits to their industry, until Worker's Compensation realizes the waste of the medical methods to back problems, until these and more is done, we can expect to remain out of the loop.
Indeed, the tyranny of the status quo is no where better evident than in the health care system. The AMA is a virtual monopoly more concerned about profit than doing what is best for patients. When medical authors declare that 80% or more of elective surgeries are unnecessary, something is terribly amiss, yet nothing changes. I doubt we will ever crack their stranglehold on this industry with our downtrodden profession--we are just too small, too inept, too fragmented and too poor to match the money and power of the AMA et al.
The only hope we have is to know that one-third of Americans seek alternative care to their health needs. The Eisenberg study revealed that this group of college educated yuppies have and will continue to support non-MD groups as long as we continue to get the good results they are looking for. Chiropractic has a uniquely vital treatment that everyone needs. Whether or not we are politically correct may not affect these aware patients who are willing to pay out of their own pockets for proper health care. But if we ever have hopes to reach the masses who need spinal care, we must penetrate the system with calls for better care and freedom of choice.
Who knows--maybe we might just reach a formerly closed-minded administrator whose own health problem was only solved with chiropractic care. Maybe we'll reach a politician who wants to do the right thing for his/her constituents and make all types of health care available. Maybe Worker's Compensation will tire of paying millions for ineffective back surgeries and finally read the convincing research accountings done by Manga and AHCPR. Who knows, maybe our profession will attain its rightful place in the health care system and someday become politically correct. Perhaps then chiropractic will considered the "in" thing to do. But it will be only these enlightened minority that will understand and appreciate our care.