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Ohio House Bill 276: Another scheme to increase chiropractors' income and achieve PCP status

Ohio House Bill 276 specifically authorizes a chiropractor to administer, sell and provide advice regarding dietary supplements, homeopathic remedies and non-prescription drugs "to restore and maintain health."  Giving nutritional advice was already part of chiropractic scope of practice, but this bill makes it explicit that they can administer and sell these substances. The bill passed in the House and has moved to the Senate Committee on State and Local Government. 

Restoring and maintaining health with dietary supplements and homeopathic remedies is going to prove tough. As an Australian government report recently concluded, after an extensive review of the evidence, homeopathy is worthless for any disease or condition. Of course, anyone with the most basic knowledge of chemistry and physics could have predicted that result because homeopathy's proposed mechanism of action is nonsensical.

As for dietary supplements, a 2012 systematic review of randomized controlled trials of vitamins, minerals and the top-selling herbal dietary supplements concluded their use was unnecessary in Westernized populations, with the exception of Vitamin D and fish oil.

But I doubt the point of HB 276 is "to restore and maintain" a patient's health. It is to allow chiropractors to sell dietary supplements and homeopathic remedies to patients, while posing as a physician with the education and training to diagnose and treat any number of conditions. In other words, to act as a primary care physician. Don't believe me? Read on.

The practice of chiropractic is defined in the Ohio statutes as

"utilization of the relationship between the musculo-skeletal structures of the body, the spinal column, and the nervous system in the restoration and maintenance of health . . . and the specific vertebral adjustment and manipulation of the articulations and adjacent tissues of the body."

Allow me to translate: the law permits chiropractors to find and diagnose the mythical chiropractic subluxation and correct it with adjustments based on the anatomically incorrect view that the spine can become "misaligned" and adjustments can put it back into "alignment."  According to chiropractic philosophy, the nebulous subluxation can "interfere" with the nervous system. Because the nervous system controls many bodily functions, the chiropractic view is that these subluxations can thereby cause all manner of health problems. Remove the subluxation and health is restored. This is Chiropractic 101. You'll note that no other health care practitioners, such as MDs, nurses or physical therapists, subscribe to this view of human functioning, and for good reason.

Nutritional therapies were not originally a part of traditional chiropractic paradigm, but, over the years, chiropractors have managed to add nutritional advice to their scope of practice. Ohio is no exception. Nothing wrong with nutritional advice, as long as its evidence-based. But if you're giving evidence-based advice on supplementing the diet, your window for recommending dietary supplements is quite narrow. As mentioned, it's Vitamin D and fish oil.

The Ohio State Board of Chiropractic has given a boost to chiropractic scope of practice with this particularly generous interpretation of the law, enacted as a Board regulation:

"The practice of chiropractic will include and permit the use of such diagnostic and treatment procedures as are taught by board approved chiropractic colleges except as prohibited by law and/or the rules of this board." 

Among other things this means that Ohio chiropractors are permitted to use venipuncture, blood analysis and urinalysis as diagnostic tools.

So, as long as a diagnostic procedure or treatment procedure is taught in one of the chiropractic colleges, unless the Ohio Legislature or the Board specifically prohibits it, it's legal. This seemingly innocuous provision is actually quite significant. The Council on Chiropractic Education, which accredits chiropractic schools, recently announced that all schools must prepare students to

"practice primary health care as a portal-of-entry provider for patients of all ages and genders focusing on the inherent ability of the body to heal and enhance function without unnecessary drugs or surgery."

This is the goal of the American Chiropractic Association as well. Your DC wants to be your PCP. (You can read much more about this over on Science-Based Medicine, which has extensively documented this effort. Click here and scroll to the end of the post for a list.)

The Ohio State Board of Chiropractors, in its approved continuing education courses, supports this view that chiropractic practice extends far beyond musculoskeletal conditions. Courses include:

Endocrine System: "Overview of all hormones with special focus on estrogen dominance, metabolic syndrome, adrenal fatigue." (Adrenal fatigue is a fake disease invented by naturopaths.)

Nutritional Support for Chronic Fatigue Syndrome

Chiropractic and Pregnancy, including how to recommend homeopathic remedies and herbs for pregnant patients.

To summarize: Traditional chiropractic philosophy had nothing to do with back pain. It was always viewed as a "primary care" practice of sorts, because it addressed what was believed to be the root cause of all disease -- the chiropractic "subluxation."  Modern chiropractic has retreated from this view somewhat, but you will see many chiropractors still advertising some version of this explanation for what ails you. But some portion of chiropractors (how many, we don't know), as well as the ACA and the CCE, want to take chiropractic back to its roots with a big difference. They don't want to be limited to the old-fashioned subluxation-based view of chiropractic practice, but they want to retain the idea that chiropractors are qualified to treat anyone with virtually any disease or condition.

Now, let's see how House Bill 276 might fit into their plan.  Here's the full list of what chiropractors can administer and sell to their patients if the bill passes:

"vitamins, minerals, phytoneutrients, antioxidants, enzymes, glandular extracts, botanical substances, herbal therapies, homeopathic remedies, [and non-prescription] drugs . . ."

Let's look at a few of these substances. Phytoneutrients are chemicals found in plants that help protect it from bugs and viruses. There is some evidence that eating plant-based food containing phytoneutrients can protect against disease, but the evidence is mostly inconclusive. Here, the bill is referring to dietary supplements made from phytoneurtrients, where the evidence is even more attenuated. Glandular extracts are dietary supplements made from dried and ground animal glands, such as bull testicles. They are considered substandard medical treatments, but are touted by "CAM" practitioners as an alternative to proven drugs for endocrine and other disorders, although the evidence doesn't back this up and they can have serious side effects. Herbal therapies are essentially drugs in plant-based dietary supplement form. There are thousands of these on the market. Homeopathic remedies are used for just about any disease or condition, although, as stated, they are worthless for any of them.

In addition to the substantial issues with the efficacy of these products, there is no pre-market safety testing by the FDA either. As has been demonstrated a number of times, they may contain actual prescription drugs and contaminants, such as heavy metals. There is no way any seller of dietary supplements, including chiropractors, could claim the products they sell are safe, barring their being USP certified, which less than 1% of supplements on the market are.  The conditions and diseases these products claim to treat are virtually limitless. And few of them have anything to do with the musculoskeletal system.

In sum, HB 276 is but one more step on the road to the "DC as PCP." Chiropractors in Ohio already have a broad scope of practice that includes diagnosing and treating such things as endocrine disorders, "adrenal fatigue," chronic fatigue syndrome and making recommendations for herbal remedies in pregnancy. (Google "Ohio chiropractor" and you'll find even more examples, such as a chiropractor treating diabetes.) Anything they learned in chiropractic school in apparently fair game. They can diagnose using some laboratory testing.  And, if HB 276 passes, they will be able to administer and sell dietary supplements and non-prescription drugs, adding a substantial array of remedies (even if not efficacious or safe) to their treatment armamentarium. They will become, in essence, the chiropractic version of the naturopathic doctor, another iteration of "CAM" practitioners who claim they are primary care physicians.

If you are willing to go beyond the evidence, sometimes far beyond, and you have the legal authority to sell supplements and homeopathic remedies to your patients, you can increase your bottom line. I happened to be in on a conference call recently with the Colorado Department of Regulatory Affairs (DORA) discussing its current review of naturopathic practice. Britt Hermes, a former licensed naturopath who was also on the line, told DORA that, for some naturopaths, selling supplements and homeopathic remedies was a major part of their practice income.

A move toward PCP status with the added bonus of increased income! The only thing left to conquer primary care is prescription drugs. Chiropractors have already gotten that privilege in New Mexico and are gunning for it now in Wisconsin. In small increments, they are reaching their goal. Regrettably,  the medical societies and legislatures are clueless

Points of Interest 05/30/2016
Chiropractic Irony

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