By: Dr. Clem Martin D.C.,
Bonham, Texas

Not long ago, I attended a coding seminar taught by a prominent leader in one of our National organizations. As commonly occurs in such seminars, the instructor shared an anecdotal story of successful treatment of a young asthmatic patient in his practice.

Ever interested in how high profile and politically connected chiropractic physicians conduct their practices, I posed the question: “did you record an asthmatic code as your diagnosis?”  My seating location was front center where my query was picked up on the audio system and could not be missed by anyone in the auditorium. The speaker hastily and emphatically responded, “I don’t treat asthma, I treat subluxations.”

It is spellbinding how conveniently many otherwise brilliant chiropractors drape themselves in the sanctimonious ambiguity of subluxation when queried on specificity. 

Nearing completion of 50 years of clinical chiropractic practice and 73 years of personal reliance on chiropractic application for comprehensive healthcare, “I don’t treat asthma, I treat subluxations” expressed publicly by a leader in the profession is paralyzing.

A lifetime struggle of persecution, joy and love of this profession has not made the vertebral subluxation etiology a plausible reconciliation for the spectrum of human disorders. Things such as Medicare Guidelines demanding level of subluxation rather than diagnostic accuracy haunts this profession with no resolution in sight.  These same constraints now threaten sustainability of Chiropractic as a health care entity.

The question exists: “is this all there is?” Is nonspecific subluxation all that is chiropractic? If treatment is nothing more than take an x-ray of the neck or back, mark a bone some direction or another and whack it 3 times per week for 6 months, what is the science  and art to  something so  ridiculously simple?  Why the need for an academic degree, a graduate degree and continuing education to whack a Bone Out Of Place (BOOP)?  Why did my State Licensing Board quiz me about Yaws and Elephantiasis, Measles and Pertussis? 

Scores of technique peddling messiahs have attempted to justify the “S” word (subluxation) with linear concepts. Most had noble motives.  Each was and remains a player in polarizing our profession. All sought a simple reductionist explanation of an incredibly complex multimodal system.  Each and every technique application has affected countless instances of miraculous outcomes. 

Our legacy is success where other treatment forms failed.  Our focus on back/neck pain was a survival tactic in the dark era of 1960/70’s AMA inquisition. Resultantly, our patient population narrowed to musculoskeletal pain.  Disorders once served successfully by the Primary Care chiropractor seem now submissive to malevolent allopathic failure and long term negative consequence.
  
We must assert to the scientific community that it is not merely subluxation reduction, but consequent modulation in Central Nervous System function at the core of chiropractic methodology.  Subluxation  may  be  one  of  a  short/long  term sign  or  symptom  pattern  yet  to  be   cataloged.  Remember, the spine and segmental dysfunction, or subluxation, is not chiropractic’s private domain.    We have squandered millions in legal funds attempting to establish copyrights for "subluxation." To what avail?  Others are "doing it" too, or seeking to do so. 

The functional outcome of the chiropractic application is as equally complex as the human system, but not impossible to rationalize in the systems logic of contemporary neuroscience.  Modulation of the human autonomic nervous system is the Chiropractic domain.  Mechanical input (energy) in the appropriate vector, amplitude and velocity fire appropriate afferent receptor populations with great end organ specificity.   Chiropractors should be the world's best at it. 

Why should we not treat the asthmatic child and call it what it is – Asthma? Why should we not treat Chron’s Disease, identity it, code it correctly and document the favorable consequence? Why should we not put cardio Amplifiers/ECG’s on our heart patients and allow them to witness the sympathetic/parasympathetic outcome as a result of the chiropractic intervention?  Why should we not repeat the influenza successes of the 1918-1919’s in this new century? Why  not aggressively assert our role as primary care providers/physicians? There is but one major hurdle besides state and federal bureaucratic law--Primary care is difficult and demanding.

While Medicare, CPT Coding and clinical guidelines and other bureaucratic measures discourage accumulation of clinical evidence that validates efficacy of Chiropractic intervention in the scope of human disorders, it us up to the doctor to determine at what level he or she desires to practice.  The individual gets to decide at what level they will function--primary care or secondary care--and regardless of bureaucratic hurdles, we must ask ourselves, have we completely succumbed to the addictive simplicity of Quick – Dumb - Profitable?