Why Should Chiropractic Should Abandon the Alternative Title

Why Chiropractic Should Abandon the Title Alternative Dr. Michael Raucci

Since its inception chiropractic has presented itself as an alternative to Western Medicine and in the late 19th and early 20th centuries chiropractic offered a legitimate alternative as people’s sole provider of health care advice and an alternative to mainstream medicine’s bloodletting, leaches, and potions. In the past 75 years, Western Medicine has made major advances which have resulted in substantial increases in quality of life and lifespan. To accomplish this medicine has relied on the adoption of the scientific method as its guiding beacon of truth. The scientific method along with peer review creates a formal and somewhat inflexible method of advancing scientific knowledge. It can still be corrupted by big business to generate profits and perhaps is appealing in its sterility to almost no one outside the scientific community but it remains the gold standard of scientific proof. Results, when properly attained, help modern society to wade through the claims of lore, anecdotes, and glitzy marketing schemes.

In the past few decades, chiropractic too has begun to seek answers using the model of the scientific method and peer review. It appears that this movement has split the chiropractic profession into two groups. I will call them the Collaborators and the Autonomites.

The Collaborators, myself included, want to work in conjunction with modern medicine to define and offer the best options for every patient. Cooperation in research benefits patient groups and a healthy referral system and collaboration amongst doctors of all types provides benefits for individual patients. The Collaborators, in general, are disciples of the scientific method and are unwilling to accept treatments, systems, or interventions that do not pass the scrutiny of the scientific method. The Collaborators prefer to operate under the umbrella of Complementary Medicine.

The latter group, the Autonomites, prefers to remain completely independent of Western medicine for fear of losing their autonomy. They fear that cooperation with medicine may result in the insidious elimination of chiropractic as a separate field of health care, in much the same way that osteopathic medicine has become indistinguishable from allopathic medicine. The Autonomites also have their patient’s best interests in mind but believe that they can handle most non-emergency maladies without concomitant medical consult. They are generally willing to allow practitioners of various systems, regardless of method, outcome, or scientific rigor, provided they operate within the laws of the state. The Autonomites prefer to operate as Alternative Health providers, maintaining their independence from allopathic medicine.

Why do the Autonomites suffer from this paranoia? Well they have every right to. Organized medicine tried very overtly to eliminate chiropractic in the 1970’s (Wilk vs. AMA) and many medical doctors are consumed by an unfounded prejudice against chiropractic, probably due to false impressions first created while in medical school. There is currently a medical doctor in my town that absolutely refuses to refer or give patients referrals when requested to see me based upon his bias. Similarly, a neurologist who practices in the neighboring town whom I share many common patients with, tells every patient not to go to a chiropractor because they cause people to have strokes. This despite the most recent evidence showing that the incidence of stroke following a chiropractic visit is no greater than the incidence in a primary medical doctor’s office, indicating that people who do have the misfortune to experience a stroke while in the chiropractic office were likely in the midst of a dissecting aneurysm when they arrived and were going to have a stroke regardless of the chiropractic treatment.

But I feel that as a profession we need to rise above the fray. Our goal as chiropractors should not be to become the primary providers of health care. It should be to become a respected part of an integrated health system. In terms of autonomy, with the growing support for national health care, a transition will occur. That transition will be dominated by the influence of Western Medicine. Chiropractic would do well to not be seen as a disgruntled competitor or as a bastion for oddball doctors who practice unscientific treatments. Chiropractic risks being further marginalized by non-inclusion. What better way to show our intelligence and worthiness than to allow medical doctors to experience our competence within a cooperative model. Chiropractors need to drop the animosity and the rhetoric and take the high road. The face that chiropractic needs to put forward is one of intelligence, cooperation, and committed empathy to our patients and we need to quiet the few but overly loud zealots in our ranks. Unfortunately, these few loud individuals who share the same professional degree as the rest of us are contributing to our professions perceived reputation to a degree which greatly exceeds their numbers.

Is it ok to have a fringe element in the profession? I believe the answer is yes, but the profession needs to know the efficacy of the procedures its members employ so that patients who are seeking treatment and medical professionals who might want to make referrals can do so in an informed manner. Currently, with few exceptions, if a medical doctor makes a referral to a neurologist or a gastroenterologist or a physical therapist they know exactly what their patient is going to experience. The same cannot be said of a referral to doctors of chiropractic whose philosophies, systems, techniques and protocols are as numerous as the doctors themselves. Fringe players need to brought out of the shadows and exposed to the scrutiny of the scientific method and peer review.

I am not suggesting that chiropractors be relegated to the same caste as the physical therapists, where patients typically can only seek medically directed care after a referral from a medical doctor. It is important that chiropractic remain a portal of entry provider. The high level of education achieved by the chiropractor alone demands this. I feel, however, that chiropractic should see itself as a specialty. Certainly, our bread and butter would be the treatment of spinal, paraspinal and nerve root injuries but we should also market ourselves and see ourselves as Conservative Management Specialists. Not being able to prescribe drugs or perform surgery is a blessing not a restriction. Because of that limitation in treatment scope, chiropractors cannot opt for the easy treatment. We have to think of ways to manage problems without drugs or surgery (We are the McGyvers of health care). There is a huge market for doctors with this capacity because they provide the patient with options, options which usually lack the potential side effects of drugs and surgery. We need to chronicle what is effective and what is not and expose those whose intellectual limitations or financial avarice might otherwise squander patients’ finances or other treatment options.

It is time to shed the alternative cloak under which chiropractics dark operators hide. It is time to be seen as Cooperators. By cooperation I do not mean being blind or silent to medicine’s inproprieties. No, we still need to be the whistle blower. That is part of what a Conservative Management Specialist does. When we do these things we will find greater acceptance, greater prosperity, greater public support and greater access to patients. Similarly, there will be less negative press, less sensationalistic stories, and less misunderstanding from the medical community. Finally, and most importantly, patients will have access to a larger spectrum of validated treatment options.