Dangerous Liasons: chiropractors and drugs

Dangerous Liasons: chiropractors and drugs

New Mexico is a microcosm of the intra-fraternity war among chiropractors. The most liberal faction, "chiropractor as primary care physician," (or "DC as PCP") has gained a foothold there, but not without a fight from the traditional "straight" chiropractors.  The latter still has an undying faith in the existence and clinical significance of the non-existent vertebral subluxation, even as some chiropractors are abandoning the concept, much to the straights' chagrin.   Let me hasten to add that the liberals have nothing on the straights in the science department, simply a fervent desire to practice medicine without having to go through the bother and expense of medical school and residency.

The liberal faction scored a victory in 2008 when New Mexico become the first state to legalize a new iteration of chiropractor called the "advanced practice chiropractic physician."  (Chiropractors are all about being called "physicians.") Much to their delight, with 90 hours of additional training (yes, that's right, all of 90) these chiropractors could prescribe certain drugs of, let's just say, dubious efficacy. A few years of legal wrangling over the chiropractic formulary followed that, with the liberals mostly on the losing end.

This year, the "DC as PCP" faction is back again, with the introduction of yet another bill in their quest to become "real" PCPs.  If you were disconcerted about chiropractors prescribing drugs already prepare to completely decompensate. Senate Bill 239 was introduced by Sen. Cisco McSorley, who has proved a loyal friend of chiropractic legislative efforts in the past. The plain old vanilla variety of chiropractor would see his practice expanded to include diagnosing and treating any condition for which he has been "educated and trained."  Exactly what this education and training might be and who decides if he is up to the task is not specified. He could also used any diagnostic method unless it is invasive or is disapproved by the state chiropractic board.  

The "advanced practice" chiropractor would be subdivided into two tiers. A "Level One" advanced practice DC could administer a number of substances of questionable safety and efficacy by injection, such as vitamin cocktails, bioidentical hormones, and glandulars.  In addition, he could prescribe drugs as approved by the chiropractic board, with no input from professionals actually educated and trained in prescribing, such as medical doctors and pharmacists.  He would also be able to prescribe and administer dangerous drugs with approval of the chiropractic board, in "consultation with" but not necessarily approval of, the pharmacy board. All this with only a "postgraduate degree in a clinical specialty" from a chiropractic school, something the National University of Health Sciences is already offering. 

Level Twos could do all of this and more.  They could prescribe, inject and dispense all dangerous drugs, except Schedule I and II controlled substances, that are used in "standard primary care practice."  This would require Level One status, plus 650 additional hours in clinical training.  Or, roughly the equivalent of about 8 weeks of a medical residency. 

A similarly ambitious bill, also introduced by Sen. McSorley, failed to pass in the past.  Let's hope that particular bit of legislative history repeats itself.


Points of Interest 2/12/2014
Double Standard