500 Words About the Medical Conscience Rule

compassHave you heard about the governmental approval of a new medical “conscience protection” rule?  It allows health care workers to opt out of administering any form of medical care they feel is objectionable on moral or religious grounds. Hmm…sounds good in theory. People shouldn’t be forced to do things they find objectionable, should they?

A press release on the Department of Health and Human Services Web site says the law will “protect health care providers from discrimination.” DHHS secretary Michael Leavitt said that doctors have a duty only “to provide care that they are comfortable providing.”

But religion is a discussion hotbed and healthcare is a hot button on the front burner of that hotbed and I have a few questions and a somewhat queasy feeling about this rule.

The goal of this rule, supposedly, is to make sure doctors who are firmly against abortions aren’t forced to perform them. However, the new rule also permits emergency room workers to withhold information from rape victims about access to emergency contraception. It also allows doctors in federally-funded clinics to refuse to tell a pregnant woman that her fetus has a severe abnormality.

The U.S. Conference of Catholic Bishops praised the new rules, saying medical workers “should not be required to take the very human life they are dedicated to protecting.” The rule is scheduled to take effect the day before President Bush leaves office.  Coincidence?  Sure, like cops with white powdered sugar on a dark colored uniform.

But a large number of medical groups oppose the rule.  Wacko fringe groups?  Not quite.   The American Medical Association, the American Nurses Association, the American Academy of Family Physicians, the American Academy of Pediatrics, and 27 state medical associations. Democratic House Representatives Diana DeGette (Colorado) and Louise Slaughter (New York ) plan to introduce a Congressional resolution rejecting the Bush administration’s last-minute rules.

Perhaps they have questions like me.  Perhaps they, too, are the teensiest bit afraid of Dr. Government.  Perhaps they are wondering:

Does the law mean a doctor can refuse to treat someone who is gay? Or refuse to prescribe medications for someone who is gay and has HIV because they feel that homosexuality is wrong?

Can care be refused to someone who overdosed using illegal drugs because the doctor doesn’t approve of drug use or of illegal activities?

How about refusal of treatment of an unwed mother because they disapprove of premarital sex or having children out of wedlock?

Wait a second! What if the doctor is anti-gun? Does the law permit withholding treatment to someone who was injured by a gun?  What if it was the patient’s own gun that went off when he was cleaning it?

Should medical professionals be permitted to refuse to treat a member of any particular group who they deem as immoral?

Of course not. This is a dicey, ill-conceived last minute plan to slip in a policy that makes sense to some people on isolated religious grounds but the risks if its implementation are too great and far reaching.

 

Dr. Brett Kinsler is a chiropractor practicing in Rochester, NY who does not support the conscience rule….and no, wiseguy, this does not count as part of the 500 words.

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Honest Decompression Salesperson One Flight Up

A lawyer relative used to have a sign in his office that read “Honest Lawyer – One Flight Up”.  The oxymoronic possibilities of the phrase ‘honest lawyer’ struck me at a young age.  I would have thought, with all of the hyperbole and dogma attached to non-surgical spinal decompression therapy, finding an honest spinal decompression representative would prove to be equally difficult.  Not so fast.  This week I met Chris Peetros from the Chattanooga Group.

I am not writing to endorse any product or company and my readers know that I will not hesitate to call someone on their bullcrap when I see it.  That is why it was so refreshing to hear Mr. Peetros discuss the line of spinal decompression devices from Chatt.  I asked him numerous questions about research and superiority and each time, he answered with honesty.  There was no exaggeration, no dogma, no suggestions on how to squeeze more money out of patients.  Here were some take home points:

(1) Chiropractors are getting ripped off by spinal decompression companies.  In many cases, doctors are spending two to ten times more than a product is worth.

(2) Chiropractors in turn upcharge their patients in order to pay off these ridiculously overpriced machines.

(3) Spinal decompression is a result, not a procedure.  These machines are mechanical traction guided by a computer for accuracy and repeatability.  There is nothing magical, mystical or truly new about this therapy.

(4) Non-surgical spinal decompression is traction.  Period.  It is mechanical muscle and ligament stretching in the axial plane.

(5) There is no proof of superiority for spinal decompression to flexion-distraction or any other means of traction but some patients tolerate it better and with an acute patient, it might be easier to start slowly with a computerized traction device.  Many traditional traction devices do not have the same control of depth and rate.

None of this is news.  None of this is groundbreaking.  All of it was honest and was spoken by someone whose company sells these units.  The difference from what I can see is that Chattanooga sells theirs for a much more fair price (around 10k) and without all the hype and claims of the other companies.

Am I buying one?  Probably not yet.  I am still not convinced that I cannot achieve the same results and with better control manually.  Most of our patients do extremely well without spinal decompression so I am not sure where the advantage would be.  However, I have now located a device that I would consider using should the research so sway me.

Got an opinion or comment?  Do you have any experience with these tables?  I’d love to hear it.

 

Dr. Brett Kinsler is RochesterChiro, a skeptical chiropractor in Rochester, NY.  www.RochesterChiro.com

Neck Pain Task Force

 

The Bone and Joint Decade 2000-2010 Task Force on Neck Pain has issued some of their key findings in the peer-reviewed journal Spine.  The work of a multidisciplinary team of researchers and clinicians led by Task Force President Scott Haldeman, MD, Phd, DC, the task force concluded that neck pain is common, typically has no single cause or one single effective treatment.  They stated that chiropractic treatment is as safe as any treatment offered by primary-care medical doctors.

 

The task force found that neck pain should be classified into four grades. Grade 1 (pain that causes little or no interference with daily activities); Grade 2 (pain that limits daily activities); Grade 3 (pain accompanied by radiculopathy); and Grade 4 (pain with serious pathology, such as tumor, fracture, infection, or systemic disease). Grade 4 was beyond the mandate of the task force to study.

 

Grades 1 or 2 neck pain can benefit from a variety of treatments including: education, exercise, mobilization, manipulation, acupuncture, analgesics, massage, and low-level laser therapy.

No ‘best’ treatment exists. A variety or combination of therapies, according to what the patient wants is ideal. The task force also concluded that risk of vertebrobasilar (VBA) stroke associated with a visit to a chiropractor appears to be no different from the risk of stroke following a visit to an MD’s office. 

 

Very useful data to be produced from one task force publication.  We are pleased that not only is one of our primary methods of treatment, spinal manipulation, validated in this report, but also the use of cold laser therapy has validity in this study.

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