July 2002

Let's Face our Problems and Implement the Solution

by Joseph T. Bowles, DC

 Dr. Joseph T. Bowles, a 1977 graduate of CCCKC, has been an associate professor at his alma mater since 1996. Prior to joining the faculty at CCCKC, he practiced in the states of Missouri and Louisiana. The first five years of practice consisted of solo practice in Union, Missouri. The last twelve years of practice he resided in Baton Rouge, Louisiana and, with long-time friend and business partner, Dr. Edward M. Gavin, developed fifteen satellite clinics in two different states.

Question: “What one thing can be done by each practicing DC to not only solidify our current position in the health care arena but also help tocatapult us to an entirely new professional level?”

There are problems in Chiropractic these days — or at least there are a few problems that have been cooking in the Chiropractic kettle for a long time now and the kettle is starting to boil over. The issues of which I speak have probably become everyday life to veteran chiropractors (graduated 1977 or earlier) while those new to our profession are just now beginning to experience some of these barriers. I believe every generation of doctor can impact the problems that have become the status quo. What we need is a unified effort to resolve and dissolve those problems that stand in the way of the fulfillment of our philosophy, science and art.

            In my opinion, there are three main problems that must be dealt with to find fulfillment.

# 1.The Chiropractic profession is predominately sought out as a last option. 

            I am sure that we all agree that this has begun to change for the better in the last decade or so. Sadly, there are still too many people being subjected (or subjecting themselves) to medical procedures as a first option. Invasive forms of treatment are necessary for those who for whatever reason could not benefit from our methods.

            To be sure, it is upsetting that Americans are uneducated about their health care options and are choosing riskier methods first for most of their needs. I did not think that I would ever see the number and type of prescription drug commercials that are shown on television today. Americans have been hypnotized by the golden stethoscope. Even when a small problem arises, they are willing to resort to invasive methods first.

            It is no secret that an unparalleled number of lawsuits are happening because of the damaging effects of pharmaceutical usage run amuck. Yet, the public by in large persists in their trust. Hopefully mankind will see the folly of running to pharmacological answers first for non-emergency disorders.

            There are an overwhelming number of patients that would be better served by being in the chiropractic clinic. However, we should be mature enough to admit that patient non-compliance and limitation of matter are not always the reasons that patients do not obtain the desired clinical result. To hedge the issue and always say that it was the patients’ fault that they did not get well is the height of professional arrogance.

            Not until the public gets an understanding of what our colleagues in the medical profession are doing, will they begin to seek chiropractic care first. When they begin to seek us out first, we need to be waiting with reliable and valid methods that consistently produce the intended result the vast majority of the time. This is a problem that our profession must endure until the public comes to their senses.

#2. We are not properlycompensated as doctors.

            If you have been in practice for any length of time, you have had many people come to your clinic after spending thousands of dollars on “the other doctors”procedures with little or no positive results. Their funds are nearly exhausted by the time they open your clinic door. After a relatively inexpensive set of exam procedures and a few office visits, they can receive a seemingly miraculous turn around in their symptoms. A good thing for the patient, but would not it be more in keeping with American free enterprise ideals if the lion’s share of the compensation went to the individual who actually helped the patient?

            Many American DCs understandably have gone to lower-fee cash practices with lower overheads. A smart business move, but you have to admit that less insurance coverage shrunk the pool of people that could more readily access our services and those who could begin to pay a ‘professional’ fee. Let’s face it, the only people who do not need or have some type of health coverage in America are the ultra rich and the people who are just above indigent and do not qualify for Medicaid coverage.

            You might think, “the dentists have done pretty good without insurance.” I agree, they have done well without much in the way of insurance. However, solutions to dental problems are infinitely easier to solve than the complexities of subluxation and its attendant bodily dysfunction. Ergo, the average chiropractic case would cost more.

            An old friend of mine who is a leader in Chiropractic in the state of Missouri once made this startling statement, “Who said Chiropractic care had to be cheap?”I do not advocate outrageously high fees or endless compensation by insurance companies for patient care. However, the insurance company’s standard contract should compensate the doctor for restoring the patient’s spine toward the normal spine model.

            It would be smart on the part of the insurance companies to have a standard contract that provides for restoring the spine toward normal position. Doing so would improve the health and well being of the patient so dramatically, it would save the insurance companies tremendous sums of money in non-emergency claims. If maintenance is required but not compensated for in the insurance contract, it is the sole financial responsibility of the patient. You, the doctor, should receive a ‘professional’ fee for your services at one hundred percent pay for all services.

            Mary Kay Ash, founder of Mary Kay Cosmetics, once said, “If you have a problem that can be solved by money, you do not have a problem.” Keeping this quote in mind, our profession has little or no problem here.

#3. The Chiropractic profession has not yet to assume a solidly prestigious position of trust by the public and those in chargeof the heath care dollar.

            We have indeed begun to make headway into the halls of ‘prestigious positions of trust.’ Look at what is happening with chiropractors caring for Americans in uniform. I just recently met the chiropractor who practices on Capitol Hill in Washington DC. It is quite an endorsement when the politicians and the armed forces want you hanging out with them. Professional athletes tout our services as well. Yet, there continues to be a veiled contempt from the public for us and our methods. This is the biggest problem our profession has faced since 1895.

            So what is that one thing that would solidify our current position and catapult us upward to new professional heights? It is what I like to call the ‘Reliability and Validity Solution’ (R&V Solution). It would help expedite the majority of Americans to turn away from medical interventions and stay with non-invasive methods. It would dramatically improve chiropractic compensation. It would place chiropractic in a permanent position of trust in the minds of the public and those in charge of the health care dollar.

            So what is the R&V Solution? It has been right under our own noses for some time now. I’ve even mentioned it a little bit already. It is so simple yet so complex. The R&V Solution is the profession using reliable and valid methods to identify and quantify the VSC. Then use methods that can consistently restore the spine to normal position. What we do clinically each day must withstand the test of scientific scrutiny. The two tests of scrutiny that our methods must pass if we are to gain the entire publics’ trust and admiration is that of reliability and validity. I have personally put everything I held to be true clinically in the light of reliability and validity. It was somewhat gut wrenching, but I am better off for it. I had to drop many of my concepts that I used for years in order to stand up to scientific scrutiny. The ‘R&V Solution’ does not suggest elimination of all we do, only refinement, until the gold standard is obtained. 

            How then can we implement the ‘R&V Solution?’ If you are ready to get on with what could be another Renaissance for humanity, start by learning and implementing everything associated with the Clinical Biomechanics of Posture® (CBP®) Protocol of Care. CBP® is a full spine rehabilitative technique. It was originated by Dr. Donald D. Harrison, an accomplished chiropractor with more published journal articles than anyone else in our profession. He and his son, Dr. Deed Harrison, could possibly be the leaders in the entire area of spinal research. In addition to his DC degree, he also holds degrees in mechanical engineering and applied mathematics. He has successfully applied the laws of these two disciplines to the analysis and correction of the human spine. It is the only protocol by which you can reliably & validly quantify the VSC and consistently restore the spine to normal position. Thereby, obtaining all the benefit that comes with the achievement of this noble clinical goal. CBP® has consistently demonstrated itself as reliable and valid where other methods can only consistently provide pain relief. It is only through using reliable and valid techniques each and every day that will indeed allow chiropractic to gain the respect it is capable of achieving.

            At this point in time, there may be a few objections forming in your mind that might lead you to disagree with or question this solution.

“I already ‘correct’ the spine using reliable and valid methods.”

            The research shows that the most advanced reliable and valid methods that can be used to identify, quantify and reduce/eliminate the VSC are those of Clinical Biomechanics of Posture® (CBP®). If you are a genuine CBP® practitioner and are consistently changing spines, you know what I am talking about. If you are not using CBP® and you say you “correct” VSC, you may want to reevaluate your position.

            The peer-reviewed literature proves that the only thing a non-CBP® practitioner can consistently provide is relief of pain emanating from uncomplicated neuromusculoskeletal origins.

            Please know this, if you are a non-CBP® practitioner, you are doing a great thing for humanity and deserve your entire fee.

            However, the Mercy guidelines apply to this type of protocol of care. You are achieving only a portion of what your philosophy says you can achieve clinically. There is much more for you as a doctor of chiropractic to explore. So many new things are being uncovered about the human spine. Research and development of new methods is ongoing. You can discover it by investigation of CBP® for yourself. There is no other method that can consistently correct the spine.

“There is no such thingas normal spine position.”

            If you feel this way, once again, you may want to reevaluate your position.        Members of our profession have published papers on the normal spinal model in the world’s most prestigious journals. The peer-reviewed literature proves that normal spine position is critical to the health of the patient. The peer-reviewed literature proves that there is a normal position of the spine in the AP and sagittal planes. Look it up for yourself and see. If there was no abnormal position, why would you ever want to do anything clinically for the patient. You are assuming a ‘normal’ by saying something needs an adjustment and doing it.

“You can’t change a spineto normal position.”

            The peer-reviewed literature proves once again that CBP® is the only methodology that can consistently change the spine toward normal values for position. The non-randomized and the randomized clinical control study are the highest forms of research evidence. There are currently four non-randomized clinical control studies in the literature that prove CBP® methods can indeed change the spine to normal position consistently. More non-randomized studies and plans to perform randomized studies are in the works. It is long past the time to accept the evidence.

“It’s not just about restoringnormal spine position.”

            I firmly believe that structure dictates function. At the same time, I feel that biochemical and psychological factors do enter into the function equation. This is a new frontier in research for the most part. There is no great body of evidence that shows that restoration of normal spine position (posture) can improve the biochemistry of the body. Nor is there a great body of evidence to support the notion of restoring normal spine structure accounting for elimination or prevention of mental disturbances. This does not mean that it cannot be done. I feel it does, and with the passing of time and continued research, it will be demonstrated that it does.

            Our main role as chiropractors is to restore the normal biomechanical integrity of the spine. There must be normal structure first. Improved diet, exercise and an improved mental state are key elements, but may not be the overwhelming cause to the patients’ problems. Thomas Edison’s prophecy about the doctor of the future was right. Even he stated the human frame should be our number one concern. I would urge those doctors who feel that biochemical disorders are equal in causation to structural disorders to cooperatively work with those who can consistently restore the spine to the normal model for the betterment of humankind. Also, let us seek to develop new relationships with those outside the chiropractic profession that research the minds of men and women.

“This is all a pretty tall order.”

            Absolutely, and that is as it should be. I feel that we are closer than ever to seeing a greater fulfillment of what Edison prophetically stated many years ago. Join the Harrison family and other CBP® doctors in aiding the proliferation of reliable and valid methods within our profession.

Some Suggested Reading Material

            • The Reliability and Validity of Chiropractic Assessment Procedures.

Troyanovich SJ, Harrison DD.

Chiropractic Technique 1996;8(1):1-4

            • Review of the Scientific Literature Relevant to Structural Rehabilitation of the Spine and Posture: Rationale for Treatment Beyond the Resolution of Symptoms.Troyanovich SJ, Harrison DE, Harrison DD. Journal of Manipulative Physiological Therapeutics 1998;21(1):37-50

            • Comparisons of Lordotic Cervical Spine Curvatures to a Theoretical Ideal Model of the Static Sagittal Cervical Spine. Harrison DD, Janik TJ, Troyanovich SJ, Holland B.Spine 1996;21(6): 667-675.

            • Radiographic Mensuration Characteristics of the Sagittal Lumbar Spine From A Normal Population with a Method to Synthesize Prior Studies of Lordosis. Troyanovich SJ, Cailliet R, Janik TJ, Harrison DD, Harrison DE.

J Spinal Disord 1997;10(5): 380-386.

            • Elliptical Modeling of the Sagittal Lumbar Lordosis and Segmental Rotation Angles as a Method to Discriminate Between Normal and Low Back Pain Subjects. Harrison DD, Cailliet R, Janik TJ, Troyanovich SJ, Harrison DE, Holland B. J Spinal Disord 1998;11(5): 430-439.

            • Can the Sagittal Lumbar Curvature be Closely Approximated by an Ellipse? Janik TJ, Harrison DD, Cailliet R, Troyanovich SJ, Harrison DE

J Orthop Res 1998; 16(6): 766-770.

            • Can the Thoracic Kyphosis be Modeled with a Simple Geometric Shape? The Results of Circular and Elliptical Modeling in 80 Asymptomatic Subjects. Harrison DE, Janik TJ, Harrison DD, Cailliet R, Harmon S. J Spinal Disord 2002; In Press.