The authors conclude: "When the number one killer in a society is the healthcare system ... that system has no excuse except to address its own urgent shortcomings. It's a failed system in need of immediate attention. What we have outlined in this paper are insupportable aspects of our contemporary medical system that need to be changed – beginning at its very foundations."
In a 2012 article, Provonost wrote, "Can you imagine that most doctors learn little about the third leading cause of death in medical school? Most medical students receive little or no formal training on how to prevent medical errors and reduce preventable complications, which cause more than 250,000 U.S. deaths each year – a number topped only by heart disease and cancer."9
One proposed solution to the illegal drug problem was encouraging potential users to ignore peer pressure and "just say no." Interestingly, this strategy is not being recommended for prescription drugs. Bruce Pomeranz, MD, one of the authors of the 1998 JAMA paper, said he is not warning people to stay away from drugs. "That would be a terrible message," he said. Lucian Leape, MD, of the Harvard School of Public Health, said, "When you realize how many drugs we use, maybe those numbers aren't so bad after all."7
Does that mean that the number of deaths due to illegal drugs, suicide, HIV/AIDS, diabetes, accidents, and drunk driving "aren't so bad" either? Does it mean that we shouldn't discourage drunk driving or unsafe sex? The folly of such double standards should be obvious to all. It is time to address the real drug problem – the cultural notion that the first solution to seek for relief of life's problems is a drug. That's the drug culture we need to address.
References
1.Seife C. How Drug Company Money Is Undermining Science. Scientific American, 2012;307(6):57.
2.Woodgett J. We Must Be Open About Our Mistakes. Nature, Sept. 6, 2012:489; do1i: IO.1038/489007a.
3.Growing Research Abuses Threaten the Fabric Science and Medicine. The Back Letter, 2012;27(11):123.
4.The Consequences of Illegal Drug Use. Office of National Drug Control Policy.
5.Last Year, Millions of Parents Learned They Were Their Teen's Drug Dealer. Ad in The Week, Sept. 28, 2012.
6.Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients. JAMA, 1998;279:1200.
7.Kalb C. When Drugs Do Harm. Newsweek, April 27, 1998:61.
8.Null G, Dean C, Feldman, M, Rasio, D, Smith D. Death by Medicine. Life Extension, March 2004.
9.Provonost PJ. Re-Engineering Health Care to Keep Patients Safe. Huffingtonpost.com, Nov. 2, 2012.
Chapter Nine
Drugs, Chiropractic and Boiled Frogs
There is general agreement throughout chiropractic that we are a drugless profession. The Association of Chiropractic Colleges Paradigm, adopted by most major chiropractic organizations including the ACA, ICA, WCA, and WFC, states emphatically: "Chiropractic is a health care discipline which emphasizes the inherent recuperative power of the body to heal itself without the use of drugs or surgery."1 Yet there is an insidious movement within our profession to incorporate the use of prescription drugs, including injectables, in patient care.
Threatening Our Drugless Status
Over 20 years ago, Oklahoma authorized intramuscular and intravenous injection of "nutritional agents." What training was required? "The first injectable nutrient course consisted of approximately four hours of instruction, going through a 'hands-on' portion in which the chiropractic physician-in-attendance would take a syringe and needle, draw up a cc of B12, and inject it into an orange." Today, the training required is a mere 24 hours for a vastly expanded scope of practice, which includes "treatment for shock (emergency procedures); PICC catheter lines; intramuscular and intravenous protocols; and oral protocols. The protocols taught include: trigger point injections; neural therapy; intravenous protocols for adult-onset asthma (a sulfur detox pathway problem usually secondary to a molybdenum deficiency); adjuvant nutritional IVs for the cancer patient; and treating persistent, nonresponsive subluxation complex, a result of axonal transport defect, due to heavy metal and/or volatile organic compound poisoning of the nerve."2-4 You read correctly: an injection for subluxation complex. (This is not a parody. I couldn't make this up.)
By the way, in case you are wondering what a PICC line is, here is a definition: "A PICC line is, by definition and per its acronym, a peripherally inserted central catheter. It is long, slender, small, flexible tube that is inserted into a peripheral vein, typically in the upper arm, and advanced until the catheter tip terminates in a large vein in the chest near the heart to obtain intravenous access. It is similar to other central lines as it terminates into a large vessel near the heart."5
As an example of how this slippery slope went far beyond B12 shots, one Oklahoma DC's Web site offerings include prolotherapy, weight loss injections, fat burner injections, chelation, and bioidentical hormone replacement.6 If you're not familiar with prolotherapy, it is the injection of irritants into ligaments to treat pain. Prolotherapy carries significant risks: "After prolotherapy, these could include increased pain, numbness (very rarely even permanent numbness), infection, abscess, allergic reaction to medications injected, weakness, temporary or even permanent paralysis, headache, pneumothorax (collapse of the lung), dizziness, nausea and even death."7
Will the DCs who offer prolotherapy have performed dozens of these procedures under expert guidance in a hospital, or rotated through an emergency room where anaphylactic reactions, joint infections, etc., were treated? Or will a lecture about it in a hotel room be adequate?
All of this may seem like old news. However, the movement has expanded far beyond a handful of Oklahoma DCs. New Mexico recently passed legislation enabling DCs with 90 hours of training to use prescription drugs, including injections, that are listed in a formulary.8 There are already plans to expand the existing formulary to include "a variety of substances that are injected into joints and connective tissue to treat joint pain and weakness ... Other drugs on the proposed list include nonsteroidal anti-inflammatory drugs, such as ibuprofen, and a muscle relaxer, cyclobenzaprine. Also listed are hormones, such as progesterone and testosterone ... In February 2009, lawmakers added new language that limited oversight of the medical and pharmacy boards to dangerous drugs or controlled substances and injected drugs."
The DCs in New Mexico continue to push the envelope. "The New Mexico Board of Chiropractic Examiners and the Board of Pharmacy also are negotiating a list of intravenous drugs to add to the proposal. Members of both boards had no estimate on when the list would be ready and did not discuss what it might include. 'Eventually, we hope to expand into a larger array of prescription drugs,' said Dr. Leslie Schmidt, an Albuquerque chiropractor and chairman of the Board of Chiropractic Examiners. 'We're going to have needle injectables and IV drugs.'"9
Why Not Drugs in Chiropractic?
1. It would be contrary to the historic and widely accepted identity of the profession to add drug treatment to our scope of practice.
2. I know of no accredited chiropractic colleges that provide instruction on the use of prescription drugs, including injections of homeopathic medications,