Limited Prescription Authority for Chiropractors?

Should chiropractors be allowed to prescribe some pharmaceuticals or over the counter medications with proper training?  Some say yes, others disagree. Some regions are actually changing their laws to permit this limited prescription ability.  I spoke with Dr. John J. Triano, Dean of Graduate Education and Research at Canadian Memorial Chiropractic College and one of the best known chiropractic researchers. He’s also a former clinician at the world renowned Texas Back Institute. I wanted to gain some prespective on this issue.  Dr. Triano discussed his views on chiropractors prescribing medications but also talked about rational chiropractic and why subluxation may be the cause of the downfall of chiropractic in the United States.

The podcast episode is located on iTunes (search for “On The Other Hand” or just click here.

Chiropractic prescription authority interview with John J. Triano, DC PhD conducted with Dr. Brett L. Kinsler.

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New CCE Standards Will Improve Chiropractic

The Council on Chiropractic Education (CCE) has released a Draft of the proposed 2012  standards for chiropractic education.  There are some extremely important changes proposed in this draft and I urge all chiropractors (and informed non-chiropractic health care providers) to immediately comment in support of the new standards.  The major changes, with my personal comments in italics, are:

  • Removing the term “subluxation”

This is an antiquated, arbitrary term that only belongs in history textbooks.  New chiropractic students deserve a scientific premise for what they will be treating.

  • Removing the phrase “without drugs or surgery” in reference to chiropractic practice

More chiropractors and states are considering opening their scopes to allow limited prescription rights. Why should we be limiting our own scope of practice?

  • Modifying language from its definition of Chiropractic Primary Care Physician that distinguishes a chiropractor from other types of primary care physicians.

Chiropractors are primary spine care and even primary musculoskeletal care but we are not primary care physicians. You simply cannot have it both ways.  If we cannot use drugs or perform simple surgical procedures (removing a splinter or prescribing an aspirin) we are not primary care doctors.  The definition with respect to chiropractic education requires modification.

I applaud the CCE for drafting language that will do much to improve and reform the chiropractic profession.  The time is now for chiropractors to embrace actions that will lead us into rational, collaborative, scientifically sound practice and denounce that which may have had its time but now is holding us back.

I hope you will do as I have done and provide the CCE with your strong support of these proposed changes.

The deadline for providing feedback on this issue is Sept. 24, 2010.

A link to the current draft and a response form are posted on the CCE website at:  http://www.cce-usa.org/

You do not need to complete the response form in detail. It is enough for you to state that you support the CCE’s draft as written.

Kill a Subluxation

When I had a back injury that first brought me to a chiropractor, my father asked me what the injury was. I told him the doctor said I had an L3-L4 subluxation. No, my father explained, that was just some nonsense the chiropractor made up. What was the real problem? Oh, well it turned out to be a herniated disc — but that was my welcome into the world of chiropractic subluxation.

It may not surprise you to know that for as long as I have been writing this blog, even though there is no topic that is more inherently chiropractic as the subluxation, I have hesitated to address it. Seemingly so integrated into chiropractic history the concept to me is antiquated and unnecessary to modern, evidence informed practices. I have avoided discussing this hotbed of chiropractic silliness due to the lack of good that usually accompanies such a can-opening of any similar collection of worms.

Now, however, thanks to recent statements on the vertebral subluxation complex from the General Chiropractic Council in the UK and the British Chiropractic Association, I have selected to be silent no more. Instead, I have chosen to be paraphrasic. The statement from the General Chiropractic Council (GCC), appears here:

http://www.gcc-uk.org/files/page_file/guidance_on_claims_for_VSC_May_2010.pdf

There is much in there with which to agree and also with the BCA‘s positive reaction to it. I am borrowing heavily from both as I develop my own affirmation:

The chiropractic vertebral subluxation complex is a historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns. This is not to say that chiropractic treatment is not effective and important — but it is not lifesaving. Subluxations are not fatal.

Chiropractors must make sure their own beliefs and values do not prejudice their patients’ care. Furthermore, chiropractors must provide evidence based care, which is clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of the practitioner.

Any advertised claims for chiropractic care need to be based only on the best research of the highest standard. Think this is a no-brainer for everyone? I suggest you see what Bill Esteb over at Patient Media thinks about using evidence in advertising (http://www.patientmedia.com/blog/2010/05/rct_and_the_cult_of_scientism.html) Hint: he thinks it’s stupid.

In light of the absence of supporting evidence I do not support the concept of the vertebral subluxation complex as the cause of disease and serious illness nor am I in favor of teaching vertebral subluxation complex theory to chiropractic students in any other context than historical and theoretical.

I fully support and encourage the inclusion of chiropractic into mainstream healthcare and know that in order to facilitate this integration we need to discard ambiguous terminology and unsubstianted historical concepts. We need to emphasize an evidence-based care model that is easily understood by the other members of the healthcare delivery team.

I feel that chiropractors should refrain from making any reference to vertebral subluxation complex in any media to which their patients or the general public may have access.

Chiropractors are the leaders in non-surgical spine care and there is strong evidence to support the inclusion of chiropractic in musculoskeletal healthcare initiatives. Chiropractors have been shown to possess specific expertise in the assessment, treatment and management of spinal and joint pain and are well-placed to deliver cost-effective services within mainstream healthcare. Let’s not mess it up by speaking another language that other healthcare professionals don’t understand while waving the lunatic flag of our now dead forefathers. There was a reason for the reliance on subluxation dogma in this profession. We needed to prove ourselves separate and distinct from medicine in courts of law. That time is passed. We’ve also given up on that whole flat Earth thing. Get over it and move on.

The GCC and BCA statements are the best thing we’ve gotten from England since Hugh Laurie and perhaps we should all strive to be a little more British.

Dr. Brett L. Kinsler is a skeptical chiropractor in Rochester, NY who is 1/4 British — but is now working on increasing that ratio.

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