Ep 23: Chiropractors and Prescription Rights. Two College Presidents Sound Off: Winterstein and Clum

It was called House Bill 127 (HB 127) and with it, the New Mexico State Senate considered legislation to permit limited prescription drug rights to a group of "Advanced Practice" Chiropractors. The bill passed the house but not the full senate. The chiropractic formulary was to include some anti-inflammatories, a common muscle relaxer, and several other topical and internal substances. Proponents said this law would permit chiropractors to help with the drastic shortage of PCP's in NM and also help patients reduce their medication usage. Opponents said this law flew in the face of our chiropractic forefathers who fought hard to preserve our drugless profession.

I wrote a blog article on this topic on the RochesterChiro blog which attracted some heated debate and strong opinion. For more depth on this issue, I wanted to speak to two people who went to the hearings in New Mexico concerning this bill. I contacted Dr. James Winterstein, president of National University of Health Sciences and Dr. Gerry Clum, recently retired president of Life College of Chiropractic West.

Poll from Dynamic Chiropractic April 9, 2011 Edition

Would you support broad advanced-practice rights, such as those proposed in New Mexico, in your state?
Yes 1295 (50%)
No 1259 (49%)
Not sure 34 (1%)

Total: 2588

National University of Health Sciences

Life College of Chiropractic West

New Mexico Bomb Shelter and Pharmaceutical Rights for Chiropractors

New Mexico Chiropractic Scope of Practice

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  • Richard E Vincent DC

    Well presented and illustrates the deep chasm of internal division in the chiropractic profession. Should the standoff continue, the profession will ultimately wither on the vine. It is time for BOLD and AGGRESSIVE leadership that defines who we are and how the profession fits in the delivery system….. all in the public interest

    Mar 31, 2011 at 10:13 am
  • Tim Pham

    I think people often forget that some medicine is in line with the idea that the body’s ability to heal itself is a powerful thing. For example, when a medical doctor gives a patient pain medication, they give the drug so that the patient can function while their body heals itself. Nothing in the mechanism of action of these drugs state that it rebuilds the damaged tissue. It is the body that handles that.

    I agree with Dr. Winterstein on his example of Vitamin C and how it’s use can be considered a drug. After all, prescription grade Vitamin D is not available to us nor is prescription grade fish-oil (Lovaza) but it’s considered a drug by the FDA. Why then shouldn’t we be allowed to prescribe certain medications? Some of use probably tell the patient to take fish-oil in the same dosage (DHA, EPA) as Lovaza!

    The last example I have is aspirin. This drug originally came from willow bark, was refined, and eventually salicylic acid was extracted and put into pill form. How is that different than Vitamin C? Taken from a natural source, refined, and put into pill form.

    Mar 31, 2011 at 7:48 pm
  • Darren D Hancock, DC

    Thought provoking discussion on the natural evolution of professional progress.

    “Legislate broadly, practice narrowly.”

    Apr 3, 2011 at 8:49 pm
  • Mark Mazz

    Great interview and questioning on the issue to bring limited medications into the chiropractic world. I don’t see the big deal or any negatives in having a chiropractor as primary care physician with pharmaceutical rights as long as they have proper training (which the students from National get I don’t know if the other chiropractic schools out there do though?). The argument that it is OK that chiropractic takes techniques from other professions like soft tissue work from massage therapist and other technologies in the medical world like MRI and X-ray to help diagnose and help treat a patient, but they can’t prescribe medications because it not true chiropractic. That question really choked up Dr. Gerry Clum argument!! Like Dr. James Winterstein said chiropractic needs to evolve to treat the patients needs and wants, if it can’t it’s doomed to fade out. Why limit our capabilities, it is only going to hurt us?

    Apr 4, 2011 at 11:44 pm
  • Abdul Ahmed

    Great interview indeed. I’m sorry to say that Dr. Clum, unfortunately, still lives in the beginning for the 19th century. I am sick and tired of these people who are not moving our profession forward because of their intimacy with the unproven theories of Palmer. I love chiropractic and if anything, bring limited drugs into the profession to be utilized by those who are trained would only improve the image of chiropractic and clinical outcomes when utilizing both therapies.

    For example: A very acute patient comes to your office, an astute doctor would provide some pain relief with drugs for several days, and then work on the source of the problem using chiropractic. Sounds like a great idea.

    Unlike Dr. Winterstein who seems really confident in his graduates’ clinical and diagnostic abilities, Dr. Clum, who was choking to answer the questions, mostly because he really has no point other than “I just don’t see” ( ya know, the typical way of proving points in the chiropractic philosophy), leads me to wonder if Dr. Clum really believes in the doctors he graduates from LifeWest? Or does he believe that his graduates are incompetent doctors?

    We are moving our profession forward. More 100 years of waiting for a miracle to come and lift our profession is more then enough. And if you want to say behind, well, I hope you don’t drown.

    Apr 5, 2011 at 1:52 am
  • J. McCrackan

    I can’t think of a single good argument made by Dr. Clum except the following: if DCs were to gain scrip rights, what’s to keep them from losing their touch (so to speak) as have DOs? A hundred years ago, DOs were excellent manual therapists, but now most of them seldom use any manual techniques at all.

    Apr 9, 2011 at 12:21 pm
  • M. Simone

    Dr. Kinsler does a great job interviewing his hosts. He asks great questions and is extremely respectful.

    The profession has gone through many changes over the past several decades. Many of the same arguments by Dr. Clum were used when DC’s considered incorporating in to their practices other treatments generally thought to be outside chiropractic, i.e. acupuncture, minor surgery in OR, injectables in OK, UT and ID.

    This issue is the most controversial I’ve seen because it goes to the heart of dogma based chiropractors. Dr. Winterstein made a great point when he discussed using OTC items as a treatment. I know many chiropractors who would rather lose a limb before agreeing to allow DC’s rx. rights but have no trouble prescribing and selling OTC items in their office for a therapeutic benefit–they are drugs, plain and simple. I remember DC’s telling their patients how bad Motrin was (when it was only available by prescription) and once the FDA allowed it to be sold OTC now prescribe and sell it in their offices.

    Will chiropractic survive if DC’s get limited rx. rights? Nobody knows but I’m betting it will thrive. Patients are searching for a provider who will offer them safer alternatives to some of the dangerous drugs they are taking. There is no reason a properly trained DC can’t fill that role. The sky didn’t fall when OK DC’s started doing IV’s 30 years ago, Oregon DC’s started doing minor surgery at about the same time, and thousands of DC’s started sticking needles in patients.

    50 years ago the argument about losing our identity if we started prescribing might have held some water but then there wasn’t one reputable research article showing the effectiveness of SMT. Now we have scores and other professions are jumping on the bandwagon. We will die if we are the only health care profession who doesn’t move forward and expand our scope of practice. I would think the dogma based DC’s would love for their DC competitors to prescribe their hearts away since it would give them a huge piece of the “straight” pie. To paraphrase Dr. Rondberg from the WCA–our organization will no longer fight the expansion battles in NM and elsewhere but will focus on promoting the positive aspects of chiropractic. If only Dr. Clum would follow his lead.

    It’s also interesting to note that the poll in Dynamic Chiropractic Dr. Clum discounted due to it’s small size was actually a sample of about 2500 doctors. That’s quite a lot more than the couple of hundred doctors Clum insisted upon. Often people will marginalize a poll if it doesn’t go their way.

    Apr 11, 2011 at 1:27 pm

    I know many chiropractors who would rather lose a limb before agreeing to allow DC’s rx. rights but have no trouble prescribing and selling OTC items in their office for a therapeutic benefit–they are drugs, plain and simple.

    Apr 12, 2011 at 5:02 pm

    formulary was to include some anti-inflammatories, a common muscle relaxer, and several other topical and internal substances. Proponents said this law would permit chiropractors to help with the drastic shortage of PCP’s in NM and also help patients reduce their medication usage.

    Apr 12, 2011 at 5:04 pm
  • Wayne Hansen

    I have recently graduated from Palmer with close to $180,000 dollars in debt. I have started my own practice and I never was told it was going to be this hard or bad. Insurance companies don’t respect us, and many of the public do not see us as physicians. I have been frustrated with our limitations placed on us by our own profession. I have also always been frustrated that we have never wanted to be associated with being a back doctor even though 90% of us are back doctors.

    We as a profession we have held ourselves back even though our founders were very progressive. And on the things they didn’t progress on like drugs and surgery we not done because of the fear of being jailed for practicing medicine. We now live in a day where every patient of mine that comes in is on some kind of drug.

    If we want to stick to the basics we need to get rid of lasers, any instruments like activators or proadjusters, etc.

    Dr. Clum seemed angry during his conversation. It always seems like chiropractors who want to hold back the profession get angry and defensive and don’t make sense in their arguments. Also having dealt with Life West students during board reviews and also taking part 4 up there I wouldn’t trust them much more either.

    Apr 26, 2011 at 2:30 pm
  • seattle back pain

    Chiropractic saves patients money by reducing their need for pain medication. Many drugs merely mask pain without addressing its underlying cause. Chiropractic goes to the root of the problem, helping patients live pain-free without the use of medication. Say NO to ALL drugs!

    May 27, 2011 at 1:27 pm
  • Dr. D

    If you’re interested in following this topic there, there is a group of progressive chiropractors pushing and organizing in this nationwide effort. If you want to stay up to date on this topic, find us on Facebook under, “Chiropractors for Prescriptive Authority.”

    Jun 17, 2011 at 1:14 pm
  • Bill Doggett

    The legislation that failed to pass in New Mexico did not change the current statute that allows limited prescription of ibuprofen, diclofenac, naprosyn, and other anti-inflammatories. It also allows the injection of sarapin, procaine, and homeopathics. The failed legislation would have permitted, with the addition of a masters post-gradate program in clinical chiropractic and 400 hours of clinical rounds, the use of any legend drug. Everyone seems focused on drugs for pain relief but those are limited to anti-inflammatories and all controlled substances were specifically excluded except testosterone and codeine for cough syrup. The ability of chiropractors to function fully as PCP’s must include the ability to prescribe medication for acute and chronic asthma, type I and type II diabetes, HBP, high cholesterol, and antibiotics. Some of these are needed for use during the initial conservative treatment plan while others are needed on a long term basis. Using chiropractic training in nutrition, exercise, homeopathic and herbal medications (yes they are drugs when used for therapeutic purpose) will help a large percentage of patients but there will be those that fail to lower their cholesterol or BP with conservative methods. Those can be co-managed with a medical specialist just the same way as a medical generalist does now. If PA’s and nurse practitioners can do that type of work with a master’s level of education and appropriate clinical rounds why would Dr. Clum and others I have encountered feel that DC’s can not be educated to the same level. No one is claiming that the current chiropractic education would allow prescription authority or that direct clinical experience is not necessary to supplement the chiropractors level of education. The advanced practice chiropractor is just that, a chiropractor that has advanced training to provide services beyond the general chiropractor and help fill a work force need that will be met using physician extenders that all have allopathic treatment philosophies. The chiropractic philosophy of innate healing and conservative approach will not die with prescription rights.

    Jun 17, 2011 at 1:32 pm
  • jess

    One can say that being a doctor we can’t prescribed medicine? lets see if we are consider real doctors can chiropractors prescribed drugs, absolutely, the debates goes against the philosphy of chiropractic medicine, we as doctors know manipulation is consider non-invasive surgical procedure, we as chiropractic doctors always been doctors from day one, we need to increase the scope just osteopathy did in past to be a while rounded physician.

    Jul 31, 2011 at 5:23 pm
  • phoenix chiropractor

    The Yes’s and No’s are about evenly split. The one thing about chiropractic care based approach is that it is not about running to drugs as the first option. It’s about helping the body to heal itself.

    Aug 4, 2011 at 9:32 am
  • Chiropractors Birmingham

    its realy very good that, you want to help patients by reducing their medication usage.

    Aug 9, 2011 at 3:16 am
  • Alan Himmel, DC

    I am a DC and see my patients in a medical office, so there is both an MD and a DC in the office at the same time. I have found that very often I end up with the patients that were originally coming in to see the MD, because they want something more. I have also had patients that originally came in to see me, but then ended up going to the MD for pills. I am not afraid to say that I think prescription rights for chiropractors would be a good thing. I am not sure if we should be able to prescribe everything, but we certainly should be able to prescribe “certain” meds for pain. After all, most of our patients are coming to us for pain. These drugs can be helpful at times. Why should we be limited like this? By the way, there is a grass roots association that is taking off like wildfire. It started in FL. Their main goal is to expand our rights. Dr. Himmel

    Jul 13, 2012 at 11:42 pm