)f Chiropractic Response by TAC Editorial Board Member Dr. Tedd Koren, D.C. Dr. Tedd Korea writes, lectures, practices and in his spare time, fights the Federal government for health freedom on the never-ending investigation of his patient education literature from Koren Publications. A former chiropractic college founder and teacher, his literature is used in chiropractic offices throughout the world. He is presently in great demand as a lecturer and speaker. Koren speaks on chiropractic subluxation, research, childhood immunizations, mind-body healing, vitalism and mechanism—all subjects on which he has written articles for TAC over the past years. Dr. Tedd Koren has been an active member of TAC's editorial board as long as we can remember. In response to Dr. Sportelli's views on page 8 in this issue of The American Chiropractor, Dr. Tedd Koren writes: I do not share Dr. Sportelli's interpretation of our present, or future. He likes to use emotionally charged terms (chiropractic is "under siege") to get our dander up and accept his fix. It reminds me of politicians who create a "national emergency" and use the concern to push a bill through with their favorite pork. Let me illustrate. He writes "the future of chiropractic is challenged" and to meet this challenge we need enough "data" to support our inclusion into "every government and private insurance plan." Dr. Sportellli appears to be looking at third party pav r- ilv government, insurance companies—to "save" the future of chiropractic. That is a serious mistake. If we permit those agencies and organizations to DEFINE WHAT CHIROPRACTIC IS, IS NOT, CAN DO AND CANNOT DO. They will tell us what "conditions" we may "treat," what we cannot "treat," who we can "treat," who we cannot "treat." They will regulate the type of patient literature we keep in our office. They will define "Wellness" and "Maintenance care." Dr. Sportelli does not mention the definition of chiropractic that government and third parties will use in defining us. What model will they use? Alhough MD's may have "lost control", as Dr. Sportelli puts it (a debatable claim), they have not lost power. The medical model is still used in government and industry; and, if we are to be "accepted" by them, it'll be largely on their terms. As the Eisenberg studies from the New England Journal of Medicine and the Journal of the American Medical Association revealed, people are spending Sbillions out of pocket for alternative health care, and the numbers are growing. There are more visits to chiropractors and other "alternatives" than to all primary care medical physicians. I see great opportunity. I want us all to jump on that train leaving the station, not get bogged down into reliance on government and 3rd party payors that will define us using a medical model (i.e., Mercy type guidelines)! If that occurs, we will become medicalized and marginalized by government and insurance companies. Quite a lot of DCs are doing just fine, thank you. I meet many DCs at my seminars whose practices are booming. There are DCs who are not doing well, I agree (but not so badly as many MD's). The public is turning towards natural foods, natural childbirth, breast feeding, questioning childhood vaccination and questioning the medical model of treating symptoms with drugs and surgery. They are turning toward us, and our non-medical model of health. If they turn to us for alternative care, will they then hear, "Sorry, I can't adjust your child who has ear infections (ADD, autism, diabetes, etc.), because the insurance (HMO) says she has to have low back or neck pain. Oh, I'm not permitted to adjust children anyway." Chiropractors have traditionally offered an alternative, not just to drugs and surgery, but, in an increasing number of cases, to the medicalized world of insurance, HMO's and federal and state government plans. If medical organizations have "lost control" over their finances, it is because they became totally and completely dependent upon third party payors. But we are now seeing MD's Continued on Page 21 ..from page 18 resisting HMO's; and we're seeing new relationships in health care forming. The marketplace can be very dynamic. I think MD's could learn from chiropractors-we've been extremely creative in developing payment plans of all shapes and sizes (cash, family plans, etc.). The emerging model that Dr. Sportelli says we must satisfy may be, itself, eclipsed by a different model; by putting energies in that model, we may be putting ourselves at risk. Dr. Sportelli talks of "enough data to support the inclusion of chiropractic services into the 'core benefit' of every government and private insurance plan." What kind of data is he looking for? One of the things we learned from fighting the Federal Trade Commission or FTC (it's going rather well, by the way) is that the data liked by government agencies is Controlled Clinical Trials, which are designed to test pharmaceuticals. They are not a good instrument with which to assess chiropractic, as the Office of Alternative Medicine is realizing. However, drug companies and MD's, who greatly influence insurance companies and government agencies, like expensive CCT's very much-although they may be useless in determining the usefulness of drugs, they keep alternatives out of the marketplace. The Mercy document liked CCT's, but (I can't say it enough) CCT's are NOT suitable for chiropractic research. Dr. Sportelli's approach will further marginalize chiropractic into a low back pain mentality. That will not get our foot in the door, it will get our foot crushed. Here is his way of saying we're good for muscukoskeletal problems "...chiropractic care is fundamentally less expensive and, particularly for those conditions where evidence is significant, the therapeutic effectiveness is validated." Dr. Sportelli writes, "Chiropractic...must concentrate much of its efforts on providing accountability and demonstrating responsibility to those who pay the bills and, finally, to those I often forgotten patients who use the j services of chiropractic." | I do not agree. We should do | research for the sake of improving j patient care, not for making insurance j companies and government agencies, j controlled by the medical model, I happy. Our research will be further skewed toward the musculoskeletal model, as so much is today. Dr. Sportelli talks about NCMIC funded research and follows it with that statement, "It is only through these kinds of efforts that the profession will throw off the blanket of mysticism surrounding chiropractic and enter into the world of meaningful dialogue with those empowered to advance the profession." There you have it from the same man who stated "innate intelligence is bullshit" at a Palmer College address to students. And just who are those "empowered to advance the profession?" I think Dr. Sportelli shouldn't hold back on giving us the names of those he feels should lead us. Dr. Sportelli is simply willing to cast off any philosophy ("mysticism") that will stand in the way of his version of chiropractic (really manipulative therapy) getting accepted by government agencies, government bureaucrats, big-insurance and big-medicine. He is only too happy to watch us divest ourselves of our uniqueness and reason for being. This is a sell-out of chiropractic put in so many words. Dr. Sportelli should reflect on an article that appeared in JAMA trying to figure out why people visit alternative providers. The answer was often for PHILOSOPHICAL reasons. Perhaps there is more to this "bullshit" than Dr. Sportelli realizes? Dr. Sportelli, finally, says something useful: "the ultimate arbiter of what will happen to chiropractic is the consumer." Exactly! And let's see where the consumer is going-it's to alternative health care, not medicine. They want "choices", not a bland form of chiropractic that is really just "manipulative therapy." And they are doing it in spite of what insurance companies, HMO's and government Continued on page 37 KOREN CONTINUED .from page 21 agencies wish to pay. When Dr. Sportelli writes: "it is time that chiropractic removes the voodoo mask it has been hiding behind and provide the face of competence and evidence," I applaud him, because I think he is saying we should divest ourselves of the voodoo of pseudo-medical philosophy and pseudo-medical chiropractic education as taught at some particular chiropractic colleges, and, instead teach students the art, science and philosophy of our truly non-medical, non-mechanistic, vitalistic approach, which this over-drugged and over-medicated world so badly needs. I think he's saying we must divest ourselves of unscientific voodoo pro-childhood vaccination and pro-"antibi-otics is good for ear infections" statements, such as those made by the ACA, and put in The Wall Street Journal while he was an executive on the ACA's board. That is what he's saying, isn't it? Dr. Techl Koren may be contacted at 215-699-7906 or [email protected] ♦ Be sure to read Dr. J.C. Smith's response to Dr. Koren and Dr. Sportelli on page 19 and fill out our reader survey on page 3 of this issue ofTAC. Response by TAC Editorial Board Member Dr. J. C. Smith, D.C. In response to Dr. Sportelli and Dr. Koren, J.C. Smith writes: Reading these two responses about the future of chiropractic, I found myself in the middle of two arguments going two different directions. On one hand. Dr. Sportelli is speaking about our market share, access and parity, research to validate our services, clinical and cost-effectiveness studies to justify to the insurance payers the reductions via our methods of SMT. Indeed, a very pragmatic approach to fighting our battles. On the other hand. Dr. Koren speaks in different terms of our profession's future: uniqueness, philosophy, alternative health care, mechanistic vs. vitalistic. He says little about economic or political issues facing our profession, or gaining market share as Sportelli does. Instead, Koren sounds to me like a member of the religious right harping against inclusion into the mainstream for fear of losing our "uniqueness" and being contaminated by the pagan, "mechanistic model" of government and the medical world. Indeed, a very idealistic approach. I believe these two divergent arguments about our future needs clearly illustrate the two approaches taken by our national associations. Dr. Koren fears that, "Dr. Sportelli's approach will further marginalize chiropractic into a low back pain mentality. That will not get our foot in the door, it will get our foot crushed." Instead, Koren sites the Eisenberg study as evidence of the trend to alternatives and suggests that our profession should ignore placating the government-payers' pleas for accountability and, instead, focus on pieusing the patients' desire for alternatives. Dr.Sportelli, however, suggests that "the future of chiropractic will be impacted by research to validate the components which are being looked at by payers, government and employers who are, ultimately, funding the healthcare costs." Sounding a bit more pragmatic, he also i mentions the trend to CAM and sees : chiropractic's inclusion from "unorthodox" to becoming a "core | benefit" and a "standard of care." j Whereas, Koren thinks our i collective foot will be crushed using | this approach, Sportelli believes it i crucial to substantiate our work via; research and CCT's—controlled | clinical studies. Just look at the lost opportunity we had five years ago when the ACHPR guideline on Low \ Back Pain (LBP) was released, and the chiropractic profession did very little to embellish and disseminate this wonderful federal guideline. Instead, we have nay-sayers in chiropractic who decry this study for fear it would pigeon-hole us into the LBP realm. Two different viewpoints of our future going in two different directions, each wanting the best for our future, but each opposed to the means to achieve that end. This is the stalemate that has plagued this profession for years, and most recently with the WCA opposition to the ACA-ACC's VA inclusion bill. For fear of being typecast into the low back pain business, Terry Rondberg and his WCA lobbyist testified against the ACA-ACC's wish for direct-access, full-scope care by DCs. Instead of gaining access and parity for chiropractors, this chiropractic obstructionist caused the entire chiropractic language to be deleted from the VA bill. Rondberg defended his position in terms similar to those used by Koren—loss of "uniqueness," detrimental to "subluxation-based" DCs, etc. For some reason, these straights seem hellbent on obstructing any legislation that One of the chiropractic profession's most prolific authors. Dr. J. C. Smith has written several excellent books: The Path to Mastery in Chiropractic; Seeking Excellence in Practice; and How to Avoid Back Surgery; Chiropractic ...The Proven Method for Back Pain, and his most recent work, a novel entitled, Poisoned Love; When a Chiropractor and an Orthopedist fall in love.... A very passionate and dedicated writer, J.C. Smith has been an active member of TAC's editorial board for the past 4 years. He's contributed several opinion pieces for TAC, for which he is famous, as well as his very popular practice management series excerpted from his book The Path to Mastery in SMITH CONTINUED ...frontpage 19 emphasizes NMS conditions. As Koren mentioned, "Our research will be further skewed towards the muscu-loskeletal model, as so much is today." What I find most odd about this disdain for treating musculoskeletal disorders (MSD's) is the fact that most DCs treat MSD's mainly; and they, too, first became acquainted with our profession as patients suffering from MSD's. While Koren prefers speaking about chiropractic's effectiveness with organic disorders like "ADD, autism, diabetes, etc.", the fact is that only a small percent of our cases include these disorders. Just as I resent Rondberg's efforts to obstruct full-scope chiropractic care into the VA program, I also resent Koren's efforts to cause dissension amongst rank and file chiropractors by suggesting that principled DCs don't care for common back pain cases. Our problem is not research on LBP, or the effectiveness of SMT on MSD's, as Koren believes. This issue is not one that pits "vitalistic, subluxa-tion-based" DCs against those who work with MSD's primarily, such as the 90%+ of those field DCs. As Sportelli mentioned, "The ultimate arbiter of what will happen to chiropractic is the consumer." Although Koren agrees with that notion, he then denigrates SMT as a "bland form of chiropractic that is really just 'manipulative therapy.'" Call it what you may, but this "bland form of chiropractic" has achieved great CCT's in every comparative study, helped millions of Americans avoid disability back problems, saved millions from unnecessary back surgery, and has gained the confidence of Americans who turn to us for their spinal needs. Perhaps an ideal model of chiropractic care would be completely different from what today's marketplace thinks of us—as the "last resort" back doctors. "In the future, the doctor will not give drugs, but will interest his patients in diet, exercise and the care of the human frame." In an ideal world, there would not be the present over-medicated society, with too many ineffective surgeries being done. In an ideal system, DCs would be a front- line alternative to the medical methods, if, if, if... And it's these "if s" that separate Koren from Sportelli. This is where Koren's idealism ends and Sportelli's pragmatism begins. If DCs are denied access to the patients, nothing will happen. While "subluxation-based" DCs want to talk about the "force behind the matter," we "patient-based" DCs want to talk about "best practice" methods that rehabilitate spines, not cure diabetes or ADD. But, if we, as a profession, are to make any headway into the marketplace, it's going to be the facts and figures from research funded by Sportelli and NCMIC which will lead the charge. While Koren may espouse hyperbole to stretch the scope of our practice beyond what CCT's contend, the MCO guys want facts to support our contentions that we can save them money, improve patient outcomes, and give patients a choice in their healthcare matters. My real problem with both argu- Continued on page 37 SMITH CONTINUED ...from page 20 ments is, why can't they work together to bring out the best of both worlds? Just as the 13 original colonists learned to work together by overcoming their religious and philosophical differences, why can't we DCs put aside our differences? Instead of look- ing at Sportelli and mixers as the enemy, why can't Koren and others like him see our real enemies: the AMA, MCO's, pain, disease and suffering. Hopefully, someday these chiropractic obstructionists will stop shooting rubber bullets at their colleagues, and focus on these very real targets. Dr. Smith can be reached by phone at 1-800-336-2013; fax, 1-912-929-8822; e-mail, [email protected]. ♦ Editor's Note: We want your perspective! Be sure to fill out the reader fax survey on page 3 in this issue ofTAC.
