Chiropractors' attitudes toward drug prescription privileges

Chiropractors' attitudes toward drug prescription privileges

Chiropractic & Manual Therapies, an open-access chiropractic journal, has a new article out on chiropractors' attitudes toward drug prescription privileges. It is not itself a survey, but a narrative review of 7 surveys of chiropractors in Europe, Australia, North America and Mexico.  As with chiropractic in general, opinions are all over the board.

Those who oppose prescription privileges cited the loss of identity as a "drugless" profession.  The lack of chiropractic education and training in pharmacology and toxicology, which amounts to a paltry 12 hours, is also a barrier.  Note that this figure belies the ridiculous claim that chiropractors are able to function as "primary care physicians."  Let's assume this would even be possible without their scope of practice including prescribing rights. (It's not.) Chiropractic PCPs would still need a thorough knowledge of  pharmacology and toxicology to function safely and effectively in that role. It would be impossible to manage a patient without understanding his medications and how they affect him, even if you couldn't prescribe them. That fact alone disqualifies them as PCPs.  (There are many others, but we'll leave it there.)

And here's another scary thought.  According to the article, 

North American chiropractors as a group were of the opinion that only 39.8% of all pharmacetical prescriptions filled annually were clinically beneficial.  

How they came to this position with only 12 hours of education on the subject is suggested by the authors:  such an attitude might be more related to philosophy than evidence-based practice.  They got that right.  Unfortunately, this conclusion leads the authors in the wrong direction:

the legal right to prescribe certain drugs to patients . . .  would include the right of un-prescribing these same drugs.  For example, if given limited prescriptive authority, this would enable chiropractors to advise patients against overuse and over-reliance on medications such as analgesics, NSAIDS, and muscle relaxants.  Therefore, chiropractors may  not all agree on prescribing rights in chiropractic, but perhaps all could unite on the issue of prescribing rights related to counseling patients on medication use?

So, they want the right to prescribe drugs so they can discourage patients from using them? Even though the authors realize their education is woefully inadequate?  Do they not realize that advising against the use of a drug takes the same amount of education and training as prescribing a drug?  

The push for prescription rights may be spurred by physiotherapists (physical therapists) gaining the right in the UK in 2012, a move that was supported by UK physicians.  According to the Chartered Society for Physiotherapy, in addition to drugs for chronic pain, specially trained physiotherapists will be allowed "to give their patients treatments for conditions like asthma, neurological disorders, rheumatological conditions and women's health issues."  Chiropractors see physical therapists, especially those who hold doctorates, as nipping at their heels in the race for musculoskeletal specialty dominance. For years, chiropractors have been successful in getting turf protection from their buddies in the state legislatures by limiting the procedures physical therapists can perform, even though there is not a shred of evidence that chiropractors are bettter at it.  In fact, the patient is better off with a PT, who is generally acting under some physician supervision and won't be telling patients their health is threatened by imaginary subluxations. 

Even with their anti-drug bias, surveys showed that a substantial majority of chiropractors do recommend OTC drugs to patients, including NSAIDS, which chiropractors love to hate. Pain-relievers were, in fact, what the majority of pro-prescribing authority chiropractors wanted to be able to prescribe: NSAIDS, analgesics and muscle relaxants, both OTC and prescription. In Switzerland, one of two jurisdictions in the world allowing chiropractors to prescribe, their formulary is limited to analgesics and NSAIDS.  Which is what you'd expect from chiropractors who brand themselves as specialists in musculoskeletal problems. 

Not in the other jurisdiction though.  That would be New Mexico, where one must be an "advanced practice" chiropractor to prescribe.  This exhalted status requires all of 90 additional hours of education and training more than the12 hours they've already earned in DC school.  There is an unintentionally comic juxtaposition of the two formularies in the article. On the Swiss side, we see a list of analgesics, such as dafalgan, and NSAIDS, such as naproxen.  In the New Mexico column, we find:

Hormones for topical, sublingual, oral use

  • estradiol
  • progesterone
  • testosterone
  • dessicated thyroid

In addition, we see "homeopathics requiring prescription" and "other substances by injection," including sterile water and saline (presumably for prolotherapy) and caffeine. 

The article glides right by this one, never calling attention to the fact that this is a nonsensical mish-mash of real, substandard and fantasy drugs. It is a perfect example of just why chiropractors should not be allowed to prescribe as well as the folly of their claiming they can serve as PCPs.

Thank goodness it's just two jurisdictions in the world. Really small ones too. That is more than enough. 














Points of Interest: 09/25/2018
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