The expansion of the scope of practice of chiropractors to prescribe drugs is an absolute non-starter for me. In recent weeks, this conversation has moved to center stage, as evidenced by activities in the states of New Mexico, South Carolina and Alabama, as well as at the biennial gathering of the World Federation of Chiropractic (WFC). 

Legislation proposed to expand the authority of chiropractors in New Mexico to prescribe broadly failed; the South Carolina measure appears to be mired in committee; and the Alabama State Chiropractic Association voted down a proposal to seek such an expansion. The WFC, while presenting a forum on this issue, has not changed its policy that the practice of chiropractic is without drugs and surgery.

The battle lines are rather well-drawn and clear. One element within the profession seeks to alter the history, tradition, conceptualization, culture, laws and regulations under which we have existed throughout our entire existence to include prescription authority of various extents. This view is being opposed by members of the profession who object and perceive the very heart of our clinical approach being hijacked and transformed into the practice of medicine.

"Conflicts Clarify!"

A recent legislative hearing in New Mexico did just that: it clarified the intent and extent of the drug lobby in chiropractic. In the past, whenever the question of prescription authority in chiropractic came up, it was always related to injected vitamins and nutritional support, as opposed to the common understanding of prescription medications associated with the practice of medicine.

In Santa Fe, N.M. on March 17, 2011, the veil was pulled back on that charade as representatives of the National University of Health Sciences and University of Western States joined members of the executive committee of the New Mexico Board of Chiropractic Examiners in seeking legislation that would allow the use of "primary care drugs." Further, these representatives indicated that they were part of the solution for New Mexico's primary care shortage with their willingness and self-perceived ability to treat patients with hypertension and diabetes, among other maladies. It is now clear and on the record that this is not about nutrition in any shape or form; this is about the practice of primary care medicine under the auspices of a chiropractic license.

During the recent meetings of the assembly of the WFC, held in Rio de Janeiro, our European colleagues repeatedly referenced Switzerland as an area of the world with prescription drug authority extended to chiropractors. In the process, it became clear that the "prescription" authority given to a chiropractor in Switzerland is the ability to tell a patient to take anything; the patient can walk into a pharmacy and buy without a recommendation of any prescriber. If the chiropractor suggests it, the federal health insurance will pay for it. The chiropractor has no authority for recommending drug use beyond that which every Swiss citizen possesses on their own!

This dialogue is laden with overlapping, confusing and variable meaning terms that must all be clarified for any rationale conversation. For example, what is a drug – a regulated/controlled product to address a specific health care circumstance. Some will point to the inclusion of high-dose vitamin therapy as potentially being removed from the practice of chiropractors if these products were defined as drugs, and therefore restrictions will exist if provisions aren't made forthe prescription of "drugs." Further, the question of what a prescription embraces must be considered.

In the United Kingdom, the recommendation for a patient to obtain a lumbar support or a rib belt requires a "prescription." In the U.K., the British Chiropractic Association (BCA) polled its members on their thoughts about "prescription" authority for chiropractors. As the concept of what required a prescription was far broader than prescription medications and included products routinely associated with chiropractic practice, the survey question received considerable support. It must be noted that they never sought to address the specific question of prescription medications and never sought to involve members of the other three associations in the U.K. that collectively rival the size of the BCA.

For this conversation to be meaningful, regardless of which side of the question you support, the terms of reference must be understood. Additionally, the strengths and weaknesses of literature and survey data brought in support of this position must be appreciated.

FULL STORY