A recent personal health crisis brought a practical example of the role of chiropractic into sharp focus. As passions heat up over the contentious issue of scope expansion and prescription privileges, and with no real information about what health care consumer/patients actually want, anyone who has an opinion about the issue is making a lot of value-based assumptions. With that in mind, and with the historic and inclusive ACC Paradigm of Chiropractic as a starting point, here’s one man’s story and some potential insights for the profession.
Hospitalized for an inflamed gall bladder in August of this year, incidental findings revealed an often-paired set of genetic anomalies: a bicuspid aortic valve and badly dilated ascending aortic root. After multiple consultations, more tests and a lot of consideration, both were scheduled to be replaced at the end of October. The surgery went fine, but a lot of additional attention was paid to the awareness that (presumably) under the stress of surgery, my heart has tended to go into (asymptomatic) atrial fibrillation.
Atrial fibrillation is a serious, often life-threatening condition of asynchronous chamber contraction. It increases the chance for clot formation, valvular insufficiency, etc. The three classes of anti-arrhythmic drugs are prescribed in a global marketplace that is of staggering size: a Global Data forecast report sees the market going from $4.6bn in 2013 to $5.7bn by 2023. The US share of the market was 59% in 2013, forecast to be 42% in 2023. I have now been put on the main anti-arrhythmic Amiodarone twice after surgeries which permitted conversion to a normal sinus rhythm. I’m personally grateful for its action.
But I’m also aware that I didn’t do what needed to be done prior to surgery: I didn’t ensure that a chiropractic examination and treatment would help optimize the function of my parasympathetic nervous system–required for sympathetic inhibition–and I knew my back was out. Some will wonder why that matters. The answer goes back to basic neurophysiology: the parasympathetics need to be able to function to inhibit sympathetic responses. I’d planned on it, but the complicated planning for family needs displaced it. Bad on me.
So the insight about our profession in all this came out of a conversation I had with a cardiac electrophysiologist several days post-surgery. I was in atrial fibrillation, and he stopped by to help weigh and consider the different options. After he was done, I spoke up.
“Well,” I said, “all that makes sense. But I’m a chiropractor, and my clinical paradigm is one of optimal neurologic function. And what I don’t know is how well my own parasympathetics are able to be involved in helping my body’s own innate intelligence mediate a response to the profound insult surgery creates for my body.” I detailed why I thought that was possible: my own poor pre-surgical planning. I braced myself for anything from a terse, polite acknowledgement of my concerns to outright dismissiveness of my perspective. What came back, though, shocked me.
“Oh,” he answered respectfully. “I totally agree. As a matter of fact, what we don’t know is how to best prepare someone for the stress of these kinds of surgery. What you say makes absolute sense, and as a matter of fact, I can draw even further parallels.” He–a medical doctor–then detailed a ‘bigger tent,’ drug/drugless approach inclusive of both medicine and chiropractic to these kind of very common problems in medical practices. I was stunned: I’d just been lectured about the power of chiropractic in more articulate terms than I’ve heard from most of my profession over the last thirty five years. We talked about additional implications for areas serviced by the vagus nerve, etc. Summation and the potential value of the chiropractic adjustment was something that made absolute sense to him.
The experience left me with two areas of certainty: that we have wasted a lot of time asking many research questions that have not clarified our value, but in fact diffused it, reduced it and permitted people to think of chiropractic as a therapy instead of a paradigm. And the second is that (based on other examinations of lowered pain-killer costs, among others), if adequately formed and studied, an evaluation of chiropractic practices that optimize autonomic nervous system function and balance would be likely to reveal worldwide savings on drug costs that would be in the billions of dollars. The difference is whether or not we’re a therapy or a paradigm. As a therapy, our contribution can be studied in isolation and contrasted with competing approaches. As a paradigm, we stand alone.
It’s important to contrast this kind of opportunity with what seems to me a ridiculously immature conception of a doctor of chiropractic as a source of limited drug prescription rights. As a profession, it seems much clearer to me that we should be exploring how best to reduce the use of drugs, not facilitate their distribution. And, rather than seeking to be on an ‘integrative’ clinical team in a hospital setting where we are a therapy (with competitors down the hall in PT/OT), we should instead clarify a role of a contravening and balancing paradigm. Why wouldn’t we work hard on integrative models that create distinction and clarify our important role instead of diffusing it?
So: one man’s story. Some will read this and say, ‘but we don’t know for sure that it would help.’ And that’s true: right now we don’t. But that’s part of our problem, and food for thought about the direction of the profession. If our role is to optimize neurologic function, why wouldn’t a corollary systems approach also be to optimize health system function? A drug- and surgery-based paradigm is helpful for many; I’m sitting here as proof of that. But a drugless alternative is potentially a game changer (how much might be saved?), and we’re arguing amongst ourselves over whether or not we should be able to add to the problem instead of improving it.