I would like to begin by thanking Mr. Don Petersen and Dynamic Chiropractic for the opportunity to offer some thoughts and reflections on where we are in chiropractic and what the future may hold for us.
In certain parts of the United States, spring is just around the corner. We are accustomed to looking for the first signs of spring like fledgling Boy Scouts observant of the smallest bud or projection from the soil. We keep an eye on detail until we can be assured that in fact spring has arrived. At that point our attention to detail ceases and we need a thunderstorm or hurricane to get our attention.
We have a tendency to look at the daily movement of our profession in the same way. We have given up the pursuit of the little, minuscule signs of progress in favor of awaiting the press conference at NIH that welcomes the chiropractic world to the forefront of the discussion of the nation's health and well-being!
The little signs are in truth more meaningful and are ultimately predictors of when that press conference will in fact occur. The little signs are far more fun and offer considerable value and great sport if you see it that way.
Consider if you will the changes that are going on about us. Think of the references to chiropractic in sitcoms over the last decade. In 1987 the references to chiropractic were negative references in a dark humor fashion. In 1997 the references about chiropractic are about funny things associated with the chiropractic profession or our form of care. The current commentary represents a distinctively different viewpoint and a viewpoint that engages the public in our art and science rather than distances them from consideration of our contribution to their lives.
Think of the newspaper articles you may have encountered about chiropractic. Even if the author of a decade ago was being positive about some aspect of the profession, the article invariably began with a comment or quote from an orthopedic surgeon or some medical authority. Today what are we seeing? In a recent Chicago Sun-Times article addressing the niche being served by some chiropractors dealing with preteen and teenage athletes, the requisite medical comment came in the last two paragraphs of a lengthy and detailed article.
For those of us who have been involved in legislative matters, think how the conversation has changed in a decade or two. In 1977 and even to 1987 the discussion among legislators was about the basic value of chiropractic care and the appropriateness of expanding the interface with government and the public. In 1997 the discussion is not about the value of chiropractic care but rather about the appropriate extent of the application of that care, never the less a very different question than we were called upon to address just a few years ago.
These changes have already taken place and we will continue to reap the benefits of them. But there are even more important changes going on around us, that are even more subtle, that will ultimately accumulate to the greater recognition and acceptance of what we do and why we do it.
Have you noticed the managed care commentary in recent weeks? There is a decidedly different tone and attitude involved in the discussions of the gatekeeper. A recent article addressing the movement of certain HMOs or MCOs toward "alternative health care" (a term I passionately dislike -- more on that in another column!) noted: "Any health plan in this day and age would be foolish not to look into alternative medicine to remain competitive." The New York Times ran a thorough review of this matter on Sunday 2/2/97, p. C-10. The newspaper with 'all the news that is fit to print' observed: "They are known as gatekeepers, and they are what many Americans dislike most about their health maintenance organization." If the public is upset about gatekeepers that is one thing, but when the bean counters start to question them that is quite another.
Consider the comment from the benefits consulting firm Foster Higgins: "I'm not sure, when you look at the administrative cost, whether in fact the gatekeeper saves any money."
Let's go from the gatekeeper to the mother lode itself. A news release associated with the Sixth Annual Health Care Forecast Conference cosponsored by UC Irvine in early February ran under the headline, "Health Care Executives Doubt Managed Care Helps Patients." Take a slow deep breath and look at some of their conclusions.
- "The growth of managed health care has decreased the quality of patient care, according to a majority of health executives surveyed."
- "The survey of 162 health insurers, providers, academicians and regulators showed almost half of the respondents also believe the trend of nonprofits aligning with for-profits doesn't benefit patients access to health care."
Let's leave managed care and move on to a completely different subject: children's cold remedies. Next time you are in the old Lazy-Boy and have one eye closed and the other on "Seinfeld," listen to the new wave of ads for children's cold remedies. One major label has produced products to treat only the symptoms your child has and thereby avoid the complications and side effects of unnecessary medicine. Think about what this means from a market watch standpoint. The OTC folks have gotten the message that the public is very aware of what they are being asked to put into their bodies and into their children's bodies. The manufacturers are responding with symptom-targeted products by reacting to the public attitude for the expressed purpose of avoiding unnecessary medication and the attendant side effects.
So what do sitcoms, newspaper articles, legislative attitudes, gatekeepers, MCOs and cough medicine have to do with us? They are signs of spring! They are signs of the angst associated with the dormancy of the winter of their health care and the desire for new and greater options and horizons. They are signs that the winter of our discontent is ending and we are entering the springtime of our profession's ideas and goals.
Gerard Clum, DC
San Lorenzo, California
Dr. Gerry Clum served as president of Life Chiropractic College West for 30 years. He also is a former founding board member and president of the Association of Chiropractic Colleges and World Federation of Chiropractic. Currently, he is a member of the executive committee of the Foundation for Chiropractic Progress.