| Recognition of chiropractors as an essential part of the U.S. health care system also dovetails exceedingly well with the expanded lifestyle-based prevention efforts that must form the leading edge of health policy in the coming era. Chiropractors have always encouraged patients to take an active role in restoring and maintaining health, with particular emphasis on doctor-guided self-care through exercise and nutrition,2 and new profession-wide initiatives reflect a deepened commitment to prevention and health promotion across the wide range of parameters elaborated by the U.S. Preventive Services Task Force. All students graduating from chiropractic colleges after January 2007 have been required to demonstrate knowledge of evidence-based prevention approaches and mastery of methods for applying these approaches in the clinical setting. This wellness mandate by the Council on Chiropractic Education, the chiropractic accrediting agency, grants individual institutions leeway to craft their own prevention training programs, but all institutions are audited for compliance with the key markers spelled out in the mandate. Thus, all future chiropractic graduates will be required to demonstrate evidence-based wellness assessment and intervention skills, which presumably will carry over into their careers as practicing chiropractors.
One further goal for chiropractors in the health reform process is broadened inclusion of DCs on federal, state and private sector health policy committees of all types. Such inclusion has expanded slowly over the past decade or two. When implemented, it accrues to the benefit of the health care system as a whole, and the millions of patients it serves, by diversifying the mix of ideas and perspectives brought to the table. The knowledge infrastructure that now exists within the chiropractic profession (including many dual-degreed practitioners) justifies the inclusion of qualified chiropractors on health care committees across the board, not just those with a musculoskeletal focus.
The Role of Complementary and Alternative Medicine
Because complementary and alternative medicine (CAM) encompasses a wide range of procedures, disciplines and professions, generalizations about the inclusion of CAM in health care reform are far more difficult to frame than those for prevention or chiropractic. Single therapies like St. John’s wort for depression or echinacea for colds do not comfortably cohabit the same category as entire systems such as Chinese medicine or naturopathic medicine. But a quick perusal of the areas under the aegis of the National Center for Complementary and Alternative Medicine at the U.S. National Institutes of Health (NIH) indicates that such odd groupings do indeed reflect the current definition of CAM.
It is possible, nonetheless, to develop consensus principles, strategies and desired outcomes for the role of CAM in health reform. The final report of the White House Commission on Complementary and Alternative Medicine Policy, chaired by CAM pioneer James Gordon, MD, provides the best available roadmap. Anyone arguing for the inclusion of CAM (or any of its constituent parts) in a reformed health care system would do well to consult this document (www.whccamp.hhs.gov) for its thorough analysis and policy prescriptions.
CAM’s contributions to health reform should grow organically from its areas of greatest strength. Foremost among these is the principled and pragmatic insistence that health be understood holistically, as a summation of various life-affirming inputs and not the mere absence of symptoms. The key corollary – still not sufficiently accepted by conventional medicine – is that while single-intervention “silver bullet” therapies may dramatically eliminate symptoms (sometimes in life-saving ways), they alone are not the road to long-term, sustainable health and wellness.
Thus, perhaps the most important policy change relevant to CAM would be to shift both CAM and conventional health research budgets away from the longstanding emphasis on single intervention therapeutics and toward multi-factorial integrative and whole systems approaches. (The Ornish lifestyle program that proved heart disease could be reversed3, 4 through a combination of diet, exercise, stress management and social support provides the best model for this approach.) Whether for heart disease, low back pain, prostate cancer, or any other condition, NIH policies that funnel virtually all health research funds to single-agent (usually pharmaceutical) studies have led us into a cul-de-sac of historic proportions. This research strategy may have been effective for combating many infectious diseases, but it has proven far less applicable to the chronic diseases – cancer, heart disease, diabetes, obesity, arthritis, osteoporosis and others – that are the bane of the developed world. CAM can play a helpful role in finding a way forward. |
