October 2001

Swimming in the Mainstream:

Too High a Price?

By Gerard W. Clum, B.S., D.C., President of LifeChiropractic College West

    Over the last eight years we have seen some remarkable data come forward regarding the interest of the public in non-medical forms of health care, in what has come to be known as “alternative medicine.” While the data indicates that our care is increasingly well received, I think there are some findings in the reports that indicate that we may be paying a dear price for the privilege of swimming in the mainstream.

            In 1993, David Eisenberg, M.D.1 provided health care in general and medicine specifically with a wake-up call with respect to the growth and utilization of what he labeled “alternative medicine” when he reported that in 1990 Americans made 427 million visits to alternative care providers and 388 million visits to traditional medical providers.

            In 1997 Eisenberg2 returned with more distressing news for the defenders of the Marcus Welby era of medicine. He reported that his findings of 1993 were not a fluke but they were part of a trend that is gaining momentum with American health care consumers. The utilization of alternative care rose by almost 35% to a total of 629 million office visits in 1997 and cash expenditures of over $12 billion were recorded for alternative care payment.

            The opinions about alternative care being a “flash in the pan” or a generational oddity were being silenced by the utilization data expressed by Eisenberg and associates.

            The Annals of Internal Medicine, September 4, 2001 brought us Eisenberg3 once again with the third jewel in a triple crown regarding the circumstances of alternative care in the minds of the American consumer. Eisenberg et al. reported on a telephone survey of adults who utilized the services of conventional medical providers and alternative care providers. His findings in 2001 were as stunning as the data he presented almost a decade earlier.

            Among persons who used alternative care and traditional medical care, Eisenberg found that they had confidence levels in their alternative care providers that exceeded but were comparable to the confidence levels they had in their medical providers (81% versus 77% expressing “total” or “a lot of” confidence). When one considers the range of providers included in the data from Eisenberg, a sea-change in public attitudes can be seen. From the halcyon days of Marcus Welby medicine, where the physician held sway in the public mind to a period where the perceived confidence of the massage practitioner, naturopath or chiropractor rivaled or exceeded the physician, so much has changed in one generation!

            Eisenberg has some important information to offer us from this recent effort, the confidence question notwithstanding. For example, 79% of the public responding to the survey indicated that they felt the combination of traditional care and alternative care was better than either form of care by itself. This supports the findings of Astin regarding why consumers choose alternative care.4 He reported that less than 5% of health care consumers used alternative care because they were unhappy with medical care. Rather, like Eisenberg’s respondents, they saw the combination of care as a useful model for their health care choices.

            There were two other data sets of interest and importance for the chiropractic profession. They dealt with the viability of the explanation of the nature of the patient’s problem and the ability of the respective practitioner to listen to the patient.  In both of these categories the respondents ranked physicians stronger than alternative providers. In days gone by it was the chiropractor that was the better listener and it was the chiropractor that gave the patient a logical basis for understanding their problem and the care that was being proposed. In 2001, either we have slipped or our colleagues across the aisle have been paying attention to some of the criticisms of them and their care — perhaps both.  

            Like the albatross to the ancient mariner, these changes may be the harbinger of trouble to come. A pendulum is swinging for the chiropractic profession. We have come from the era when little data supported what it was that we did and little data existed to explain how what we did produced the results we observed. Medicine had its data, and they reveled in it.                    

            Then the data started to come into our world. This was not bad in and of itself, but it offered the opportunity for us to abandon our compassionate, humanistic, high-touch low-tech approach and find strength in the numbers, in the data, in the science. In the process we have begun to leave behind an intangible that amplifies the effect of any care-belief, conviction and passion. We have begun to make the transition from clinician-scientist to scientist-clinician.

            In contrast, our colleagues in medicine are beginning to see the value in what we are abandoning. Consider the counsel of Emory University physician and medical anthropologist Melvin Konner5 who recently observed, “However scientific they are, doctors are always shamans too. When we are in their hands, they are magical to us. Prescientific shamans claimed to recruit spiritual powers; scientific ones invoke high technology. And we want them to, because this is our wizardry. Yes, it works a lot of the time, but our faith in it goes far beyond its effectiveness. Unless we find a balance between the old arts of healing, and the new technology, we may lose as much as we gain. And the loss may be irreversible.”

            I am not advocating an end to research or turning a blind eye to data. Rather I am suggesting that we would be well served by seeking to merge the Aesclepian and the Hygiaen aspects of our care, making the tie between tech and touch an essential one for us with an emphasis on touch over tech.

            Finally, we need to regain our ability to listen, to truly hear what our patients, or in my case students, are saying. To learn from them in every conversation. This is not a function of time. It is a function of presence. A minute from someone totally present is worth hours of the casual listener’s time.

            Use the data, understand the findings and remember the magic of delivering your first adjustment. Remember the joy and potential you once saw in what an adjustment could accomplish. Relish the opportunity to enter into another person’s life in that magnificent exchange we know as an adjustment and when all else has been done, your best given, believe. It costs no more, takes no more time nor energy and just may be the catalyst to make all the rest work a good bit better!

References:

1. Eisenberg DM, Kessler RC, et al. Unconventional Medicine in the United States. N Eng J Med. 1993;328:246-52.

2. Eisenberg DM, Davis RB et al. Trends in Alternative Medicine Use in the United States, 1990-1997: Results of a Follow-up National Survey. JAMA. 1998;280:1569-75.

3. Eisenberg DM, Kessler RC, et al.  Perceptions about Complementary Therapies among Adults Who Use Both:  Results from a National Survey. Ann Intern Med. 2001;135:344-351.

4. Astin JA. Why Patients Use Alternative Medicine: Results of a National Study.  JAMA. 1998;279:1548-53.

5. Konner, M. Have We Lost the Healing Touch?. Newsweek. 2001; June 25:77.

Last issue we incorrectly used an old biography of Dr. Clum. We apologize for our error.

            Gerard W. Clum, D.C. is president of Life Chiropractic College West and has held this position for over 20 years, placing him among the most senior of chiropractic college administrators in the country.  In addition to his duties with Life West, Dr. Clum serves as a member of the board of directors of the following organizations: Association of Chiropractic Colleges, Council on Chiropractic Education, and World Federation of Chiropractic.  He presently serves as chairman of the International Affairs Committee of the International Chiropractors Association, a member of the Education Committee of the World Federation of Chiropractic and the secretary-treasurer of the World Federation of Chiropractic.  Dr. Clum has served as president of the Association of Chiropractic Colleges (1990-1995), as vice-president of the International Chiropractors Association (1987-1990), and a member of the Board of Directors of the ICA from 1983 through 2000.

            In a January 2001 survey conducted by Dynamic Chiropractic, Dr. Clum was acknowledged as one of the five top leaders of the chiropractic profession by the readership of Dynamic Chiropractic. In 2000, Dr. Clum was recognized as the ‘Volunteer Business Leader of the Year’ in Hayward, California, he was recognized as the ‘Chiropractor of the Year’ by the International Chiropractors Association in 1992 and as ‘Man of the Year’ by Dynamic Chiropractic in the same year.  He was awarded an honorary Doctor of Chiropractic Humanities from Life Chiropractic College (Marietta, GA) in 1981.  He has received numerous state, regional, national and international acknowledgements and awards for his efforts in the chiropractic profession.

            Dr. Clum was instrumental in the establishment and development of the ChiroLoan program in cooperation with Education Funding Services (EFS) of Hyannis, Massachusetts.  In addition, he has testified before various Congressional panels and subcommittees relative to student loan related matters.  He has written and lectured on cultural and sociological trends affecting the chiropractic profession and health care in general in publications and on programs throughout the United States, Canada, Australia, Africa and Europe.