International Chiropractors Association

Do We Really Need Another Prescriber?

One Respected Chiropractic Leader’s Personal Point of View 
By Robert Braile, DC, FICA
Unless you have been hiding on a deserted island the past few decades, it should not be news that the United States has a severe prescription drug problem.  In June of 2013 the Mayo Clinic Proceedings published a study showing that 68.1 percent of the U.S. population is on a prescription medication at any given time. Over 51 percent of the population is on more than one, and over 21 percent on five or more. 
Additionally, in 2011, the Office of the President of the United States issued a report titled “EPIDEMIC: RESPONDING TO AMERICA’S PRESCRIPTION DRUG ABUSE CRISIS.”  The first line of this report states, “Prescription drug abuse is the Nation’s fastest-growing drug problem.”   
The United States is the most drugged society in the history of the human race. Is it any wonder that our healthcare system is ranked 38th by the World Health Organization?  It should also come as no surprise that the U.S. ranks last in most health measures, including longevity, when compared to the top industrialized nations, all of who take less drugs than do we.  
With these undisputed facts, and the hundreds of other studies showing that our society’s health is suffering due to overmedication, the question begs to be asked, “Do we really need another prescriber?”
With this knowledge readily available, there are however chiropractors who desire to join the ranks of the prescribers by expanding chiropractic licensure into pharmacology. At first, it was fringe groups of disgruntled DCs who were grasping for straws in a misguided attempt to gain what they thought would be legitimacy.  But now, apparently, the American Chiropractic Association has jumped on the drug bandwagon in their latest resolutions by forming a College of Pharmacology and Toxicology, and creating their “Six Key Elements of a Modern Chiropractic Act,” which calls for usage of the term “Chiropractic Medicine.” 
The arguments for both these ACA moves are painted by a thin veil of “public assistance”. Groups advocating prescriptive rights in the past predominantly spoke of “practice rights,” as if giving drugs was some sort of an entitlement. However, the ACA language speaks of “restrict patients’ access to chiropractic services,” and “discriminatory policies in reimbursement” as reasoning for chiropractors giving drugs.
This reasoning lacks either any evidence or logic.  With certain states like Florida having acquired such language changes, can anyone say with a straight face that reimbursement is better now than it was before the language change?  Do we really believe that insurance companies will pay better once we add the word “medicine” to our practice act? 
The argument behind the ACA’s College of Pharmacology and Toxicology also escapes reason. The first stated objective of the ACA new college is, “To assist in the advancement of Chiropractic medicine as a science and healing art.” So immediately, we see the shift toward the word “medicine.” This also suggests that our profession will advance if we get into pharmacology.  This is just totally false. 
Another of the stated objectives talks about educational programs at chiropractic colleges. Part of this section reads, “…meaningful use criteria relating to drug-drug and drug-allergy interactions, maintain an active medication list, maintain an active medication allergy list and to implement and maintain drug formulary checks.”  This is curious language, as any recommendations related to medications are outside of the scope of chiropractic practice. Therefore a change in scope would be needed to make these classes relevant.  Ah -- therein lays the true intent.  
The ACA’s plan does not mention the responsibility or increased liability we would be subject to if we are required to maintain such drug records.  The idea also does not take into account the huge increase in exposure and resultant increased malpractice insurance premium rates all DCs will have to pay.
The ACA’s plan, thinly hidden, is to first embrace the term “chiropractic medicine” legislatively in our practice acts, such as in Florida.  Step two is to offer courses that teach pharmacology, thus to say we have the training.  Then, finally, step three is to go to the state legislatures with the argument that we are already called chiropractic medicine, and we have the training in pharmaceuticals, so we deserve a full prescriptive scope of practice.  The logic of the plan, not the reasoning, seems to make sense, IF your goal was ultimately to get drugs into chiropractic. 
But there is still one elephant in the room.  Our society does not need another prescriber. In fact, the valid argument can be made that if the pharmaceutical industry gets ahold of chiropractic, the way it has medicine, any semblance of chiropractic’s unique offering will vanish forever.  If for nothing else, the public deserves to have a healthcare provider who is not bought and paid for by Big Pharma. 
I’m sure there are some chiropractic colleges that would relish the idea of pharmaceutical giants cutting checks for millions of dollars to their institutions.  But with those thirty pieces of silver would be the loss of any resemblance of a chiropractic subluxation based education. 
If a chiropractor truly wants to incorporate drugs into their practice, why not just go to medical school and get the degree?  Why try to drag the public’s last good hope for a non-drug approach into the jaws of Big Pharma?  Are we so selfish that for a perceived short term gain, we hurt the public good forever?
Chiropractic offers an alternative to the madness and carnage we are seeing in a drug-first society. I’m all for learning about the horrors of a drug dependent society. Yes, let’s have courses on that.  But I have serious reservations that the ACA’s College of Pharmacology and Toxicology has as its educational goal the preservation of chiropractic as a drugless approach to health.  
In the end, the arguments do not come down to any public need, for none exists. The underlying rationale is money, or in this case, the perception that money will come if we head down this crooked path.  To that I can only say, “What profit a man if he gains the whole world, but loses his soul.”