I’m always struck by the paradox that those holding a big vision for chiropractic’s potential generally have a focused approach to patient care. Simply stated, those seeing chiropractic as a value to overall health and human expression generally focus their care on the correction of subluxation. Conversely, those seeing chiropractic in a more limited scope generally look for a broad-scope approach to patient treatment. Paradoxical, isn’t it?
In the profession’s early days, B.J. Palmer narrowed care to the correction of atlas/axis, realizing the impact of that specific correction on the overall biomechanics of the spine and nervous system, and therefore overall function and adaptation in evolving environments. The discussion was often limited to whether or not it was necessary to adjust other areas of the spine. That conversation of scope is long past for most DCs. Next was the controversy over extra spinal joint manipulation, then it was physiotherapy, nutrition, pillows, vitamins, etc. Through it all, I’ve held that if correcting subluxation was at the center of care, education and patient focus, then these ancillary procedures should be allowed and supported. Out of that came the positioning statement, “legislate broad, practice as narrow as you choose.” But how far do we go before the profession no longer has a distinct identity and may, in fact, no longer be chiropractic?
That possibility became a reality recently in New Mexico where a formidable group—with the backing of the Executive Committee, the Board of Examiners majority vote, the advocacy of the Speaker of the House of Representatives, and Drs. Winterstein’s (National) and Brimhall’s (Western States) appearance—was in the final stages of giving chiropractors full drug prescription rights. Arguments for both sides were significant. The drug-advocacy group pointed to a two-year master’s degree program in pharmacology offered by National—a position proponents say would fill the need for primary care practitioners in underserved areas, especially as universal coverage looms on the horizon—and that drug prescriptions were optional.
The chiropractic group argued the educational proposal was grossly lacking, therefore dangerous to the public. None of these docs with established urban practices would move to rural areas where primary care was lacking, and any doc wanting prescription rights could undergo a six-semester course of study in nursing. Also, given the intimate relationship between the colleges, NBCE and CCE, colleges would be forced to teach pharmacology to allow students to sit for licensure upon graduation.
For these reasons and more, the atmosphere was combustible. In an unprecedented move, the Speaker of the House attended all sessions to ensure the democrats voted “right”—a seeming threat to bills needing to be passed for constituents if the line wasn’t toed.
At the Senate Judiciary Committee hearing, one member commented this was really more about the scope and identity of the profession and less about each side’s arguments. He couldn’t have been more right. Maybe in the early days of chiropractic it was about “when is too little, too little?" But today the question is, “at what point do we draw the line with the argument needed to evolve the profession, to be contemporary, commit to patient-centered care, legislate broad, and practice by choice? When do we cross out of chiropractic and enter another field? Does chiropractic have to possess some immutable curbs in order for it to still be called ‘chiropractic?’”
My answer last week in New Mexico was “yes,” there must be a line that can’t be crossed. And so a group of us, with the support of passionate docs from around the world, fought for that line. In the end, the support of those D.C.s, the support of medical organizations opposing the bill, the ICA, my good friend Gerry Clum, and the New Mexico chiropractors wishing to practice in a drug-free profession (and use referrals to trained MDs when necessary) carried the day. The New Mexico legislature killed the bill; and in the end the question for me was, “when is too much, too much?”
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