By Randy Southerland
The waves of hysteria that swept across America following anthrax-related deaths and the threat of a smallpox epidemic created by terrorists seem to be subsiding. In their wake, many are wondering: Where was chiropractic, and how should the profession react to future threats of bioterrorism?
The answers, provided by some long-time observers of the profession, illustrate there are considerable differences of opinion over what role chiropractic should play. In many ways, these varied opinions parallel the divisions that have long plagued the profession.
Obviously, D.C.s can’t join emergency personnel in handling the first attack when care must be provided to critically injured victims. However, many believe that chiropractors should take a role in educating the public about how potential threats can really affect their health and the best ways to prepare for them. They can also serve as a cautioning voice against the heavy reliance on antibiotics and vaccines, particularly in cases where natural approaches are both safer and more appropriate.
D.C.s As Educators
“I think the chiropractic profession is not living up to its role as an alternative educator to the public,” asserts Dr. Tedd Koren. He joins a chorus that says the threat is overblown and that the public is only getting medical advice that may potentially be more dangerous than the diseases themselves.
In recent issues of his e-mail newsletter, for example, Koren has presented a wide variety of sources and information on anthrax and smallpox for his chiropractic readers. Among the many sources were articles on natural remedies such as oil of oregano and garlic that could take the place of more powerful, and potentially harmful, antibiotics.
While most chiropractors are reluctant to advocate alternatives to drugs, many want to know the truth about threats such as anthrax and smallpox and what they should be telling their patients, according to author and researcher Dr. Christopher Kent. In response to numerous requests from doctors, he wrote a series of articles designed to put the threats of bioterrorism, such as anthrax exposure, in perspective.
“The essence is that the threat (of anthrax) is extremely low, and there are far more significant public health problems that need to be addressed,” Kent says. “There’s a saying that if you kill one person and frighten 10,000, you’re an extremely effective terrorist.”
By that standard, the faceless terrorists who mailed letters containing anthrax-laced powder to U.S. Congressional offices and the Florida-based publisher of The National Enquirer achieved their goals.
The Fear Factor
While the victims of anthrax were few—just four people died—the widespread news coverage set off something akin to national hysteria. Many people were caught up in a stampede to purchase antibiotics. Numerous M.D.s, under pressure from their patients, were writing 60-day prescriptions for the powerful and expensive Cipro. In fact, The Associated Press reported that during the month of October, 32,000 people took antibiotics as a precaution for possible exposure.
Never mind that, even now, medical authorities say taking antibiotics in the face of a disease that isn’t widespread—and in fact isn’t even remotely contagious—is a bad idea on many levels.
For example, Philip Hanna, an anthrax researcher at the University of Michigan, says that a 60-day treatment of Cipro increases the possibility that normal bacteria found in the body will become resistant. Many of these bacteria, unlike anthrax, can cause diseases that are contagious.
It seems clear that medical authorities have been less than successful in spelling out to the public when and under what circumstances taking antibiotics is appropriate.
“Medical doctors are often practicing sloppy medicine where they give antibiotics when they’re not indicated,” Koren charges. “They won’t stand up to the patient and say no—they’re not indicated. Doctors should be teachers, but they don’t teach. They just give drugs.”
Public hysteria reached new heights just as the anthrax scare was subsiding. This time, the fear of a new terrorist attack using smallpox was instilled when Senator Bill Frist (R–Tenn.) claimed in October that, based on the strategic study “Dark Winter,” such an attack could kill 40 million Americans.
This disease was eliminated in the late 1970s when the last naturally occurring case was reported in Somalia in 1977. In 1979, a global commission certified that it was indeed eradicated, and vaccinations were no longer required for the general population.
Public fears were at least partially calmed when the Centers for Disease Control and Prevention in Atlanta issued a report earlier this year saying the predictions of mass infection were exaggerated. In fact, the basis for the study and its underlying assumptions were seriously flawed, the agency said.
The public, however, found one more thing to worry about. To prepare for a possible outbreak, the U.S. Health and Human Services Department announced that it intended to purchase enough smallpox vaccine to inoculate the entire population. The Bush administration quickly backed away from that proposal when the American Medical Association raised the specter of deaths—71,250 by one estimate and perhaps as many as 600,000 by another—from side effects.
This scare could also make individual liberty a casualty as well. Dozens of state legislatures, from Georgia to California, are taking up legislation giving governors the power to order quarantines, force vaccinations, restrict citizens’ movement, ration medical supplies during emergencies and punish doctors who don’t report contagious diseases.
These efforts, the result of a model law developed by the CDC, have gained momentum in large part because of the widespread fear of bioterrorism.
Profiting From Fear
While it’s unclear just how helpful all these drugs are in protecting the public from disease, the hysteria has clearly helped the bottom line of drug manufacturers. Bayer, the maker of Cipro, for example, negotiated a deal with the Bush Administration to mark down the price from $1.77 a pill to “just” $.95. While this represents a $.65 profit per pill, it is still far more expensive than other equally effective antibiotics, say observers.
With all the confusion swirling around this debate, does chiropractic have anything useful to add and should chiropractors get involved? A central tenet of chiropractic has long been that a properly functioning immune system, free of interference from subluxations, is the best response to the threat of illness.
Most important of all, what should a doctor say when his patient asks questions? D.C.s have to tread carefully when they’re addressing what many consider solely a medical issue.
“A chiropractor is certainly in a position to advise people about general health, not regarding the practice of medicine or the appropriateness of a specific antibiotic,” says Kent.
Vaccinations, in and of themselves, are not a chiropractic issue, according to Dr. Drew Rubin, a practitioner in Marietta, Ga., who serves on the adjunct faculty at Life University.
The author of The Adjustment, a novel that describes how chiropractic provides an answer to a worldwide plague, says he has gone head-to-head in public debates with medical doctors.
“I never say that chiropractic can cure asthma or back pain,” he points out. “It’s just that we can make the whole body work better. That’s where our thrust should be during this crisis.”
Getting people under care and healthy may be one of the most effective tools in keeping people safe from threats that literally can’t be seen by the human eye.
Some D.C.s are making their voices heard, at least with the patients in their offices.
“For many people, the chiropractor is an individual with whom they (patients) have great rapport,” Kent says. “I know there’s controversy within the chiropractic profession regarding being critical of medicine and whether a chiropractor should dispense so-called ‘medical’ advice, but I certainly think the chiropractor is in a position to address public health issues depending on the scope of their education.”
The amount of knowledge and expertise that a D.C. can bring to bear on these kinds of issues is one that some within the profession question.
Dr. Mitchell Haas, professor of research at Western States Chiropractic College in Portland, Ore., and an officer in the American Public Health Association, says that the issue is made more complicated by the ongoing debate within the profession over what doctors should tell their patients on the issue of immunization.
The Immunization Debate
The differences of opinion over how chiropractic should approach this issue is in many ways reflective of arguments that have raged since the days of B.J. Palmer. These include disagreements over how the profession should interact with medicine and in particular whether vaccines are safe and effective. Some members of the profession are more willing to accept the official government policy of universal immunization for childhood illnesses.
“It’s my opinion that when it comes to immunizations, we should be referring to medical specialists,” says Dr. Haas. “I personally think we should recommend that patients get immunizations if they are required—especially in this situation.”
He recommends that D.C.s keep abreast of the official government policy and “keep a handle on what’s coming out of the CDC.”
While the risk of bioterrorism seems remote now, that could quickly change. To prepare for that event, doctors should keep up with the latest information on antibiotics and their effectiveness.
Observers say that most patients probably aren’t asking their chiropractors about this issue because they don’t have time or don’t view the chiropractor as a source of information. In addition, most D.C.s aren’t even bringing the subject up in patient lectures.
“Patients would be looking to the best source of information on these issues and that’s not us,” says Haas. “In the same way, if people wanted to know about back problems or the risk for musculoskeletal injury in the workplace, I wouldn’t go to the local medical doctor. I would go to a chiropractor.”
The exception comes with those patients who use D.C.s as their primary source of health care. In addition, some doctors who have long railed against the use of vaccines see this latest threat as yet another way for medicine to claim credit for averting a threat that may be overblown.
Rubin, who has taken a strong stand against childhood vaccination, says that a significant number of patients in this practice have raised questions about anthrax and smallpox and the need to take vaccines.
Arming With Information
To arm themselves, chiropractors have many sources of information on these issues available to them, ranging from Medline searches to web sites and publications such as those of the CDC.
“There are certainly articles that have appeared in medical journals addressing these issues regarding bioterrorism,” notes Kent. “A number of news services have addressed these issues. The CDC has issued policy statements and, of course, it’s possible to look up—using the Physicians Desk Reference or online databases—prescribing information and potential adverse effects associated with specific drugs. So chiropractors certainly have a lot of resources at their disposal.”
Whether the profession will begin using those resources when the next crisis comes along remains to be seen. What is clear is that the arguments have just begun and where chiropractic will come down will be decided in offices and in professional debates in the months and years to come.
About the author: Randy Southerland is a public relations specialist for Life University. Inquiries should be addressed to him at 1425 Franklin Rd., Marietta, GA 30067; call (770) 426-2875 or e-mail rsouther@life.edu.