March 2011
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New Podcast Interview: Two College Presidents Discuss Prescription Rights for Chiropractors

It was called House Bill 127 (HB 127) and with it, the New Mexico State Senate considered legislation to permit limited prescription drug rights to a group of “Advanced Practice” Chiropractors. The bill passed the house but not the full senate. The chiropractic formulary was to include some anti-inflammatories, a common muscle relaxer, and several other topical and internal substances. Proponents said this law would permit chiropractors to help with the drastic shortage of PCP’s in NM and also help patients reduce their medication usage. Opponents said this law flew in the face of our chiropractic forefathers who fought hard to preserve our drugless profession.

A blog article on this topic on the RochesterChiro blog attracted some heated debate and strong opinion. For more depth on this issue, podcast host Dr. Brett Kinsler contacted two people who testified at the hearings in New Mexico concerning this bill:  Dr. James Winterstein, president of National University of Health Sciences and Dr. Gerry Clum, recently retired president of Life College of Chiropractic West.

Listen on iTunes or at the podcast website.

7 comments to New Podcast Interview: Two College Presidents Discuss Prescription Rights for Chiropractors

  • Hi Brett

    I do not feel the profession is threatened by a small group of DCs who would like to offer more than spinal adjusting.

    I do have one concern, and it’s based on the research term “confounder“: If an “Advanced Practice” Chiropractor (Medi-practor?) adjusts someone AND provides them with pain meds, how is one to distinguish whether chiropractic helped them at all? And how will that ever reveal the true power of the adjustment?

    We all know from school that some students excel in their adjusting skills, and that others don’t. Who am I to deny a DC the *right* to provide meds to (perhaps) bolster their ability to help a patient?

    It’s a shame that our profession experienced such repression by the AMA. Otherwise more DCs would be proficient at referring patients who needed additional medical support. That would have also paved the way for more MDs to refer needy patients to DCs. I don’t see that as a likely outcome if DCs pursue adopting an pseudo-medical practice.

  • Hi Frank,

    We think similarly though your point about confounding variables is really a research design issue and not an actual concern for the profession. Good research should address those factors and control for them, whether it is pharmaceuticals in a chiropractor’s office, the color of the walls in a hospital or a patient’s socio-economic status. Outcomes can be affected by numerous things – drugs are just one of them.

  • karl

    I’m not sure how I feel about limited prescription rights, however I will say it could be an advantage for the chiropractic profession to be able to instruct patients on appropriate/monitored NSAIDs use. Especially when you consider the routine use of OTC NSAIDs by a demographics. I often add to this conversation that some people should remember that having the ability to prescribe also allows one the ability to not prescribe. I also believe there’s low back guidelines that call for NSAIDs with spinal manipulation. Although, NSAIDs are recognized as potentially dangerous and overused, they’re routinely used and are also effective for many NMS conditions. A limited prescription ability could be beneficial to both the doctor and the patient. The ability to prescribe could also be effective at reducing health care cost and reducing doctor visits. I feel chiropractic is doing very well in the evidence-base arena but I do feel expanding the scope of practice could have benefits that won’t necessarily hurt our identity…it may help our identity among the public and other health care professionals.

  • Don

    As a chiropractor I understand the trepidation of expanding our profession into the realm of pharmaceutical means, even if it is a limited realm. As a medical doctor I see the need for chiropractors to have a greater understanding of the pharmaceutical means that are used today. I am a more recent graduate than most who will read this. I graduated with high honors and was and still am very active with my chiropractic school and I see first hand the major limitations of today’s chiropractic education. Yes the chiropractic education has grown by leaps and bounds but we are still lacking behind the medical programs and yes even the osteopathic programs. It is really sad that a 2 year degree in physical therapy will grant that person more rights and privileges then the 8+ years needed to obtain a DOCTOR of CHIROPRACTIC degree. It is also very discouraging when a master’s degree in acupuncture will allow an acupuncturist to inject caustic and sometimes lethal remedies when a doctoral degree (chiropractors) cannot. I decided to go back and obtain an MD degree for several reasons. The first being that with the current state of the chiropractic profession and the current cost of a chiropractic education (current grads are in debt for over $200,000), I really don’t see a choice if I want to continue to help patients. Second, it almost guarantees 2, 3, or even 4 times the income potential. I love OUR CHIROPRACTIC profession. It is by far the best form of health care we have. But the current times call for a change. We need to move forward and grow and not retract and die. The average income for the average chiropractor is falling. We should be the leaders of health care but if we can’t even tell a patient to not take that medication how can we be. We have to ask other providers to help us get things for patients (Medicare patient needs and MRI for example or a Medicare patient needs physical therapy). I am tired of watching my patients have to spend $2500-3000 to have a trigger point injection because of all the referral bs instead of being able to perform it as a DOCTOR. We chiropractors need to realize we are DOCTORS first. Read your degree, does it say chiropractor. No it states DOCTOR of CHIROPRACTIC. DOCTOR is first. If we don’t start growing and expanding and at the same time reducing the cost of the chiropractic education we are at a very near end to OUR beloved profession. My tuition increased over 25% in the time I was in school. That is just ridiculous. Having prescription rights does not mean you have to prescribe, but it does give us the ability to. It also gives us the ability to remove medications that our patients are currently on. The CHIROPRACTOR in me does not like drugs. They as a whole are usually not needed and can be bad and harmful for the patient. The medical doctor in me (and yes the father in me) says that not all drugs are bad and in fact can save lives. Just take insulin for instance or in my son’s case epinephrine. To be able to take a patient off of the often times useless or even more harmful medications can be a godsend for our profession. Plus, it will bring in a lot more patients who otherwise would not think to use chiropractic. This is why we as a profession should and need to continue to support the expansion of our profession. I am not saying that the adjustment is a bad thing or that it is overrated, but what I am saying is I do not want to watch our profession wither and die. Physical therapists, massage therapists, acupuncturists, and osteopaths all perform some form of manipulation or mobilization and they can all do more things with their patients than we as chiropractors can. We need to GROW and EXPAND or we will WITHER and DIE. It truly is our choice here what happens.

  • Hi Brett,

    I understand the term confounder. The *concept* can and should be applied to clinical practice. My alma mater used the term “specific” chiropractic to refer to adjusting what’s fixated (subluxated) and leaving the rest alone. In that respect, it is easier to determine if adjusting C5 (or Atlas) actually accomplished something. If you adjust everything, how will you ever learn what works and what doesn’t?

    It’s the same with drugs plus adjusting. I discourage my patients from using NSAIDs because of the well-documented risks. They can get similar results icing at home, or from taking Omega-3s (although it takes time to ramp up effects). Meanwhile, I see over and over that SMT all by itself is highly effective. If I am drugging them too, how can I state with assurance that it was the adjustment that helped them?

    Most patients I see shift from pain so quickly, I hardly see the point of needing to provide meds. The few severe pain patients I do see already have a box full of meds by the time they come to me.

    Again, I don’t feel *threatened* because some DCs want to prescribe. Live and let live I say.

    I feel that we are unique because we offer a clear alternative to all that. For the few that need meds, I’d rather have a relationship with an MD I can trust to conservatively help them out for the short period required to get them stabilizing.

    BTW, thanks for taking your time to tape these calls, and to craft quality questions. Your work is a real asset to the profession, and I am proud to have them on our site!

  • Christopher Perry

    A chiropractor with prescription rights is called an osteopath. If one wants to prescribe AND adjust then go to osteopathic college. Homeopathy and nutrition can do whatever the limited prescription rights can.

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