Canadian health care is in crisis mode, and we know it. The epidemic of
chronic lifestyle diseases such as cancer, heart disease, diabetes and
chronic pain is well documented.
Canadian health care is in crisis mode, and we know it. The epidemic of chronic lifestyle diseases such as cancer, heart disease, diabetes and chronic pain is well documented. The repercussions and projected challenges to Canada’s Medicare, insurance and public health networks have been well publicized. There’s no shortage of awareness of the simple fact that in terms of health care, we’re in trouble.
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The elephant in the room in our profession, however, is that chiropractors haven’t shown up to help improve the situation.
With its arsenal of pharmaceutical drugs and an antiquated infectious disease model, mainstream medicine is ill equipped to stem the tide of chronic lifestyle diseases. Theorists and health care policy makers are searching for best practices in terms of chronic disease management, yet the solution to this crisis has also been well documented – prevention.
At the centre of this epidemic lies poor lifestyle – inadequate diet and exercise habits, smoking and abusive alcohol consumption, exposure to environmental risks and chronic stress. They’re all preventable. Moreover, therapeutic lifestyle modification is now emerging as not only the best preventive measure against chronic diseases of lifestyle but also as the first line therapy for the treatment of these diseases. In terms of chronic diseases, the time to save a life is clearly . . . ahead of time!
So why aren’t we doing it? Therapeutic lifestyle modification is the wellness paradigm chiropractors always hoped it would be – it is integrative, vitalistic and preventive. Ironically, instead of leading the charge in this emerging model of healthcare, chiropractic is almost nowhere to be found.
Diabetes – a chiropractic no-show
Consider the diabetes epidemic which is acknowledged by many as one of the most important health problems of this new century. Last summer, the American College of Endocrinology released, for the first time, clear guidelines on the treatment of early diabetes, pre-diabetes (impaired fasting glucose or impaired glucose tolerance), and metabolic syndrome.1 The basis of treatment in this landmark publication was therapeutic lifestyle (diet and exercise) and prevention! Chiropractors should have been rejoicing at the thought that their clinical wellness practices could now be acknowledged as integral in the co-management and prevention of this epidemic. Is this what occurred?
Obesity – a big zero
Consider the obesity epidemic that is projected to “overwhelm” every major medical system in the world,2 “…as big a threat as global warming”, according to Paul Zimmet of the International Congress on Obesity. In response to this epidemic, the Canadian Medical Association recently launched national guidelines for the treatment of obesity. In these guidelines, again the role of therapeutic lifestyle management is clearly identified as the first line therapy for the treatment and prevention of this epidemic. Did chiropractors stand up and acknowledge their role as obesity prevention doctors?
A professional heart attack
Consider cholesterol and heart disease….consider stress related disorders and dysfunction…consider smoking and certain respiratory diseases – all modifiable, all preventable! At what point does the profession of chiropractic intervene and stand accountable in this –the single largest health crisis in human history? If we aren’t collectively addressing diet, exercise, and smoking cessation, measuring blood pressure, or impacting cholesterol etc., what exactly is this wellness that chiropractors and chiropractic institutions are selling? The leading cause of death in Canada remains heart disease, yet most DCs are still not even taking regular blood pressure measurements on patients.
We are, by our own collective non-response activity, isolating ourselves from both the population and other health care providers, wondering why utilization rates continue to drop3 and scopes of practice continue to narrow! Contrast that to all other Canadian health disciplines, both medical (nurse practitioners, pharmacists and physiotherapists) and complementary (naturopathic doctors and midwives) which have seen dramatic expansions in scope of practice and utilization!
The failure of chiropractors to directly address lifestyle, and its implication on lifestyle disease, in private practice is no longer acceptable.4 Many chiropractors and chiropractic practice management consultants still feel that wellness, for the chiropractic profession, only means regular or lifetime adjustments and this is being projected to the general public. (In fact, recently, a woman who was referred to our clinic – which has the word ‘wellness’ on the sign – said that she had been reluctant to come see me because other “wellness” chiropractors she had visited had tried to saddle her with thousands of dollars worth of lifetime adjustments. She was quite surprised to hear that wellness, in my clinic had a completely different, and much more comprehensive meaning!) The idea of lifetime adjustments, especially where there is a lack of lifestyle disease management, is as antiquated in the face of this crisis as medicines’ infectious disease paradigm or over-reliance on drug-only therapy. The working model and scope of chiropractic clinical practice has to evolve to meet the needs of the population it services. The rise and fall of any institution has historically been predicated based on its ability to address societal needs, not on its unwavering adherence to tradition or past history. Continuing to provide spinal adjustments only as the primary methodology of health propagation in this lifestyle disease epidemic is clinically weak and patently ridiculous, analogous to lifetime prescriptions of statin drugs or proton pump inhibitors for the same inadequacies of lifestyle. The time for change is now!
A prescription for change
Facilitating the therapeutic lifestyle arm in global healthcare is critical to both positively impacting the health crisis and for better integration of chiropractic into existing health care delivery channels. Step one in this process is a commitment to measuring patient lifestyle and correlating said lifestyle to both chief complaints, such as high stress, and headaches and future health risks such as high stress and cardiovascular disease. Screening tools for these factors are now available to chiropractors for clinical practice, corporate wellness and other larger public health ventures.
The second step in the process is the utilization of evidence-based biometric and laboratory markers in measuring established disease risk and relative health. In terms of lifestyle diseases, some of the established biomarkers include: blood pressure, body composition analysis, waist-to-hip ratio, blood glucose, cholesterol and others. Each of these measures directly correlates to disease risk and health status in universally understood ways! Moreover, chiropractors must also begin reporting health status of these established risk markers much like they do for spinal health – along a relative scale or continuum.
Historic event for chiropractic
In June 2010, Healthscore, a chiropractor run lifestyle measurement and biometric testing service, secured laboratory privileges for its licensed Canadian offices – a historic first for chiropractic in Canada. Although not the last word in increasing the profession’s scope of practice to include laboratory analysis privileges, this opportunity and the support offered by the medical team at DriverCheck Inc. – Canada’s largest and most comprehensive drug and alcohol testing company – was a testament to Healthscore’s commitment to both building interdisciplinary bridges and to repositioning DCs on the front line of disease prevention in their communities and in corporations. I assert that chiropractors can play an integral role in the health care crisis facing all Canadians. Requisite to success in this endeavour includes: the right tools, continued training, support of our provincial and national leaders and most importantly a keen understanding of the epidemic which has changed global health care delivery and chiropractic’s role within it.
Laboratory analysis, considered a critical tool in the assessment of health has been an unfortunate casualty in previous scope of care reductions for chiropractic. But chiropractors who become clinically certified Healthscore partners will have access to laboratory privileges/requisitions through the Healthscore-DriverCheck Network of Medical Review Officers. This historic achievement now allows Canadian DCs to facilitate wellness on par with other medical professionals.
Educating your patients
Patient education is the last but perhaps most critical component in the facilitation of therapeutic lifestyle. Chiropractic offices must commit to providing lifestyle education or lifestyle medicine as standards of practice. Building health beyond battling disease requires a firm commitment to patient education beyond the spinal health model. Every day, chiropractors interact with patients that will either be diagnosed or suffer from a chronic disease that could have been prevented or is reversible. The time for chiropractors to begin saving these lives – is now! A commitment to this model of wellness will provide our society, and our profession, with tangible hope for a brighter future. •
For article with references, please visit www.cndoctor.ca.
Steve Rallis, BSc, DC, ND (cand) – Chief clinical officer for Healthscore, and a leading authority on wellness, Dr. Rallis is committed to passionately “saving lives…ahead of time!” Dr. Rallis focuses his energy on expanding the use of primary prevention as a principal means of global health care reform and believes that Healthscore licensed chiropractors can play an integral role in this process. Healthscore is presently being used by insurers, corporations and chiropractors across Canada. A 1999 graduate of Parker College of Chiropractic, Dr. Rallis is continuing his medical education at the Canadian College of Naturopathic Medicine.
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