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Can Chiropractic Be "Integrative Medicine?" A Patient Survey and a University President Weigh In PDF Print E-mail
Written by John Weeks   

Can Chiropractic be "Integrative Medicine?" Lehman's Patient Survey and a University President Weigh In

Summary: A challenge for advocates of patient-centered care may be actually following what patients want. Take a look at the brief survey of patients by University of Bridgeport faculty member James Lehman, DC, MBA and consider its implications. Significant subsets of DCs and MDs probably won't like following patients down that path. Then look at the view of "chiropracty", I mean "Chiropractry," or is it "Chiropractice," or maybe it's "chiropractic medicine" from Jim Winterstein, DC, president of the multidisciplinary National University of Health Sciences. Both argue, in very different ways, that "integrative medicine" is not and should not be viewed as a profession-specific term.
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The discussion of whether "integrative medicine" is "by, for and about MDs" led me to state that one direction would be to cede the name "integrative medicine" to the MDs while using "integrative practice" or "integrated health care" when we are wish to be more inclusive of other practitioners. I noted that such a direction would disrespect the use of "medicine" by naturopaths, acupuncturists and some chiropractors, as well as a few score of state licensing boards, in describing non-MD fields as "medicine."

Into this discussion steps James Lehman, DC, MBA, DABCO, a member of the faculty in the chiropractic college at the
University of Bridgeport with some data from a survey of patients, and James Winterstein, DC, president of the multidisciplinary National University of Health Sciences, who goes straight to the dictionary to look at what we mean by "medicine."

1.   Patient-Centered Care: Pilot survey says patients want DCs to prescribe pain medications

chiropractic medicine, patient-centered care, survey, prescriptive authority
James Lehman, DC, MBA, DABCO
The last Integrator noted that James Lehman, DC, MBA, DABCO would be taking the "yes" position in a debate this month at the University of Bridgeport on this statement:
"The Chiropractic Profession Should Pursue Advanced Practice Training, So as to Function as Primary Care Providers with Limited Prescriptive Authority" (see Integrative Medicine and Integrated Health Care Round-up: July 16-31, 2009, July 31, 2008). Lehman has an ace in the hole to support his affirmative argument. He gathered data that suggests that, if chiropractic were to be patient-centered, the chiropractic profession would seek prescriptive authority for pain medications.

Lehman
compiled the data from active patients from two chiropractic practices in Albuquerque, New Mexico, one of which he owns. Prior to his move to Connecticut, he practiced in Albuquerque as a chiropractic orthopedist for 33 years. One of the questions was: "Would you prefer that your chiropractor be qualified to prescribe medications and provide hands-on treatment in order to control pain?" Here are the results. 
___________________________

Patient Views of Whether Their Chiropractors
Should Prescribe Pain Medications?


Number surveyed
  83

 
    Total

Percent
 Yes   73

 88%
 No   8

 9%
 No opinion

2

3%

Source: Preliminary data from a survey of patients of 2 chiropractic
practices by James Lehman, DC.

___________________________

Concludes Lehman:
"This small sample of responses indicates that the vast majority of chiropractic patients in these two chiropractic offices prefer that their chiropractic physicians have the training and licensure to prescribe medications and provide hands-on treatment in order to control pain."

Lehman is seeking to perform a nationwide survey of patients which will include this and other questions. Asks Lehman: "Is it time for the chiropractic profession to consider patient-centered care, which might include hands-on treatment and a limited prescriptive authority?"


Comment: I am wondering, assuming Lehman's more robust survey upholds these perceptions, if the conventional advocates of patient-centered care will put patients in the driver's seat on this one. Will the advocates of the patient-centered medical home, for instance, support additional training for chiropractors which would allow them to serve patients in this way? Or will a guild-centered medical marketplace rear its familiar head and continue to dominate? Notably, the Pew Health Professions Commission work in the 1990s would support Lehman's case for optional chiropractic training to expand scope for those members of the chiropractic profession who were interested in adding limited prescriptive authority to their scope. The shaping concept in the Pew work, as my colleague and Integrator adviser Pamela Snider, ND has taught me, was training to tested competency to scope. Special education of chiropractors, with appropriate testing prior to being allowed to prescribe pain medications would seem to be a perfect example of what Pew was recommending.

2.   James Winterstein, DC:  "Word games ... the term 'medicine' is not synonymous with allopathy"

James Winterstein, DC, has a unique role in the chiropractic universe. He withstood the ire of many chiropractors when he expanded the offerings at National College of Chiropractic, one of his profession's anchors, and transform it into the National University of Health Sciences. (See
Winterstein/NUHS Explore New Ground for Multidisciplinary/Integrated Education, September 25, 2006.) 
chiropractic medicine, integrative medicine, definitions
James Winterstein, DC
Winterstein also serves on the board of Integrator sponsor Alternative Medicine Integration Group, a firm which surprised conventional audiences with outcomes that whole practice chiropractors can create significant saving as primary care practitioners compared to their conventional colleagues. (See
Major Health Plan Savings in CAM-Oriented PCP Project for Blue Cross Blue Shield to Be Published January 17, 2007.) With the following introduction, Winterstein forwarded an article on the topic he'd written earlier:
"I read your excellent article 'Is Integrative Medicine By, For and About MDs?' In my estimation we cannot afford to let this term go to the allopaths. We all know that the VAST majority of them do not practice under this rubric. Furthermore, the term 'medicine' is certainly not synonymous with allopathy. I have attached an article I authored some years ago which explains my position on the term 'medicine.' The collective members of the non-allopathic professions should resist any attempt by the allopaths to take away a concept that we have practiced for decades.

Word Games
- James Winterstein, D.C.
President The National College of Chiropractic

How often in your chiropractic career have you heard someone say, so you are in the profession of "chiropracty?"  Perhaps they said "Chiropractry" (I heard that one just this morning from a business executive) or even, a more English "Chiropractice."  These people weren't mispronouncing the word "chiropractic," they simply were trying to reconcile their knowledge of English with a word that sounds very much like an adjective and is used as a noun.  When that happens long enough and often enough, the word becomes accepted (I have been told that the word "chiropractic" is a "noun cognate") but the real question is; are we just playing word games? 

   
 
Why do we continue to say
"Chiropractic" rather than
"Chiropractic medicine" which
is what nearly all of the
journalists say?
 
Why do we continue to say "Chiropractic" rather than "Chiropractic medicine" which is what nearly all of the journalists say?  Well, there I went and did it, didn't I?  I committed the ultimate heresy in our profession by juxtaposing the words "chiropractic" and "medicine."  Before you hang me out to dry, however, please let me have the chance to shed some light on the subject.

What, exactly, does the word "medicine" really mean?  The Oxford Dictionary, Second Edition, sheds some good light on this word:

"That department of knowledge and practice which is concerned with the cure, alleviation and prevention of disease in human beings, and with the restoration and preservation of health.  Also, in a more restricted sense, applied to that branch of this department which is the province of the physician, in the modern application of the term; the art of restoring and preserving the health of human beings by the administration of remedial substances and the regulation of diet, habits, and the conditions of life."

Some in our profession will argue that from this definition it is very clear that we do not fit, because in their view we do not "cure or alleviate disease" in humans, we only locate and correct the subluxation.  The obvious question then becomes, what is the subluxation if not a disease?  If it is something wrong with the human anatomy and physiology that is not considered normal, then it is a "disease" which is defined by the Oxford as:
"To deprive of ease, make uneasy, to put to discomfort, or inconvenience; and further, to bring into a morbid or unhealthy state, to cause illness or sickness."
It should be immediately obvious that even those members of the profession who profess to only correct spinal subluxation are, in fact, practitioners of the art known as "chiropractic medicine."

As we read and re-read this definition, it should become clearly obvious that all physician level practitioners fall under this definition and require only a definitive adjective for completion of the title or the educational process.  It is most unfortunate that we, as a chiropractic profession, have fallen into the trap of the word game by insisting that "we are not part of medicine!"  Rather, we should respond to any question about medicine with "are you referring to allopathic medicine?”

   
Allopaths do not represent medicine. 
They represent allopathic medicine
which is different from osteopathic
medicine and different from
naturopathic medicine and, dare I say,
different from chiropractic medicine.

 
This entire pathological word game has led us into a position that is often untenable.  We are left with inadequate explanations when members of the public say, "but how would you treat medical conditions?"  Medical conditions?  What exactly are those anyway?  Well, apparently they are things that occur which are somehow only treatable by allopaths – at least that is what we are lead to believe.  Then there are the medical diagnoses.  Again, one must ask, what exactly are those?  Thus, the public has been sensitized, over the years, to think in terms of any health concern as something for which only the allopath is the answer, because they represent medicine.  No, they do not represent medicine.  They represent allopathic medicine which is different from osteopathic medicine and different from naturopathic medicine and, dare I say, different from chiropractic medicine.

How did we get to the place where we so abhor the word "medicine?"  It is the result of our historical desire to separate ourselves from allopathic medicine, to present a picture of a practitioner who was so different from the allopath that we had nothing in common.  It is even a result of the historical reality that some within the chiropractic profession denigrated allopathic medicine as a practice which was antithetical to good health -a practice that was predicated upon pills, potions, lotions, cutting and poisoning as some from our profession have stated and perhaps still do.

What, however is really in the best interest of our patients?  Whether we like it or not and whether we agree or not, our patients (the public in general) are pushing all of us, allopathic, osteopathic, naturopathic and chiropractic physicians toward a center which the public is defining for us.  Thus, we hear
   
 
What, however is really in the
best interest of our patients? 
Whether we like it or not and
whether we agree or not, our
patients (the public in general)
are pushing all of us, allopathic,
osteopathic, naturopathic and
chiropractic physicians toward
a center which the public is
defining for us. 

the term complementary and alternative medicine (CAM).  We hear the term Integrated medicine.  In both instances, we, of the chiropractic profession, are a part regardless of what we think and regardless of our (here comes that grossly over and misused word) passions!

I believe the time has come for us to set the record straight.  We are a part of medicine by definition.  We are, however a very specific part because our philosophic position is different, and many of our practice methods are different.  We at times are an alternative to allopathic medicine.  At times we are complementary to allopathic medicine just as the reverse is true. 

It is the contention of Michael H.Cohen, that it should be a legal requirement for allopathic physicians to refer to chiropractic physicians in those instances when chiropractic care is clinically indicated.  The world is changing and we must change with it; maintain our uniqueness and still embrace the change.  We do practice chiropractic medicine and we should be proud of that fact.  It is time we just say so! [Cohen, M.H. Complementary & Alternative Medicine – Legal Boundaries and Regulatory Perspectives: Hopkins Press: 1998, page 111.] 
See related article Chiropractor as (Potentially) Cost-Saving PCP: What Fate the Broad-Scope Practice? September 25, 2006,

Note: I am among a minority of journalists who use the term "chiropractic" rather than "chiropractic medicine." I have been trained to this use by David O'Bryon, executive director of the Association of Chiropractic Colleges, who shares that this is the language his association uses, given the differences among the educator members.

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