Chiropractic "primary care" threatens to invade another state

Chiropractic "primary care" threatens to invade another state

Just as Hawaiian legislators were pushing back against the overly broad scope of naturopathic practitioners, they turned around and decided to expand the scope of chiropractic practice.  What the right hand giveth to consumer protection, the left hand taketh away.  

The bills (House Bill 1831; Senate Bill 2478) are ostensibly an attempt to modernize the legal definition of chiropractic "to fit the standards, practices, and terminology accepted by the National Board of Chiropractic Examiners."  In other words, a default to the faulty chiropractic educational system to decide what Hawaiian chiropractors can and cannot do.  Unfortunately for patients, chiropractic education simply reflects the turmoil endemic in the chiropractic profession itself.  

At one extreme of the spectrum are the traditional "straight" chiropractors, devoted to the detection and correction, via spinal "adjustments," of the chiropractic subluxation.  They view subluxations as the source of "nerve interference" which, if not promptly removed, cause ill health and disease.  In fact, the patient must be ever vigilant, going in for regular chiropractic checkups to find and eliminate subluxations.  Success is guaranteed because post-treatment examination will reveal that the patient is indeed subluxation-free.  Actually, we are all subluxation-free, but it's because subluxations don't exist, not because any chiropractor found them and took them out. 

At the other extreme is the "DC as PCP" faction, which views chiropractors as primary care physicians, able to diagnose and treat (with referral as necessary) any patient with any disease or condition.   Some members of this group want to get their hands on expansive prescription privileges, a dream that has become a realtiy in New Mexico.  This faction isn't necessarily more science-based.  They've just moved on from the subluxation to other imaginary treatments, like homeopathy and bogus diagnostics for dietary deficiencies, which they treat with dietary supplements.

And squeezed somewhere in the middle of all this are chiropractors who used evidence-based diagnostics and therapies to treat spine-related musculoskeletal problems. Their number is unknown.  Unfortunately, they are regarded as traitors by both sides in this intra-fraternal war.

The chiropractic educational system has become one of the battlegrounds on which this war is waged.  And the Council on Chiropractic Education, the accrediting agency for chiropractic schools in the U.S.,  is ground zero for those battles.  The latest skirmish took place when  Council's status as an accrediting agency came up for renewal before the U.S. Department for Education. Score one for the straights, who defeated efforts to kill them off for good. 

Naturally, the public is confused.  If chiropractors can't agree, how can the public possibly be expected to know who they are and what they do.  A recent survey reports that about one-third of the public thinks chiropractors are medical doctors.  And another finds that the overwhelming majority of medical doctors  don't know what it is they do either.  

This professional multiple personality disorder is perfectly reflected in the Hawaiian bills. The entire spectrum of chiropractic identity and practice will be allowed if this legislation is passed.   The "adjustment" is maintained as a permissible therapy, although no longer limited to the spine.  The elusive subluxation is not mentioned in the current definition of chiropractic practice, nor is it in the proposed legislation.  But (wink, wink, nod, nod) we all know what an adjustment of the spine is supposed to do.   

Under the new law, chiropractors would be able to call themselves chiropractic "physicians" and use any "diagnostic and treatment services . . . taught by an accredited chiropractic college" and approved by the state chiropractic board.  More specifically, they would be permitted to

[E]xamine, analyze, and diagnose the human body to correct, relieve, or prevent diseases and abnormalities by any physical, chemical, electrical, or thermal method; use or order diagnostic imaging; use or order diagnostic testing; and use any other method of examination for diagnosis and analysis taught by an accredited chiropractic college and approved by the [state chiropractic] board . . .

They could not perform surgery or "direct the use of legend drugs" but they could use "clinical nutritional methods." So, for example, a chiropractor could claim to practice "functional endocrinology" a bogus method that detects purported nutritional deficiencies and treats these non-existent deficiencies with dietary supplements.  (Chiropractors in Colorado and Utah are already doing this.)  Or, a chiropractor could order EKGs and diagnose heart disease.  And, if he wished, treat the patient's heart disease with subluxation detection and correction and dietary supplements.  As long as he stays away from surgery and drugs, the possibilities are virtually limitless.  

Some chiropractic colleges (like the National University of Health Sciences) are already establishing a beach head in educating chiropractic "primary care physicians" (or at least the chiropractic version of primary care).  If these bills become law, the only thing standing in the way of Hawaiian chirorpactors pretending to be primary care physicians is the chiropractic board. It will then become yet another battleground, like in Colorado and New Mexico, on which chiropractors can fight their never-ending intra-fraternal war. 

Points of Interest: 2/24/2014
Points of Interest: 2/21/2014