Call me old-fashioned, paranoid or just old, but I do remember graduating from chiropractic college in the late '70s in the midst of the Wilk v AMA lawsuit.For those of you too young to remember, in 1976, Dr. Chester Wilk and four other chiropractors sued the AMA, several nationwide health care associations and several physicians for violations of sections #1-2 of the Sherman Antitrust Act.
Wilk, et al., lost at the first trial in 1981, but then obtained a new trial on appeal in 1983 because of improper jury instructions and admission of irrelevant and prejudicial evidence. Ten years later, on Sept. 25, 1987, Judge Getzendanner issued her opinion that the AMA had violated section #1, but not #2, of the Sherman Act; and that it had engaged in an unlawful conspiracy in restraint of trade "to contain and eliminate the chiropractic profession."
Maybe the AMA learned its lesson or maybe it didn't, and don't forget I may be a little paranoid; however, today when I talk to colleagues about the new medical specialty field of lifestyle medicine, I get a blank stare. Pay attention, because this new field could threaten the chiropractic profession's ability to provide wellness care if we don't watch out.
The Premise of Lifestyle Medicine
The premise of lifestyle medicine is to focus on treating the true causes of chronic disease. Lifestyle medicine is positioning itself as the primary disease prevention and treatment modality available. In so doing, the movement crosscuts every other "alternative" health care profession, chiropractic included, and when fully developed, has the potential to be the gold standard in patient care.
Lifestyle medicine is defined by the American College of Lifestyle Medicine as "the use of lifestyle interventions in the treatment and management of disease." Lifestyle interventions can include activities such as healthy eating, exercise or physical activity, stress management, restorative sleep, tobacco cessation, alcohol moderation and a variety of other non-drug activities. The essence of lifestyle medicine, from the ACLM's perspective, is the concept of preventing and treating the true "cause of disease," rather than simply managing the symptoms of disease.1 Chiropractic colleagues, does this sound familiar?
If you have not heard of this medical field yet, where have you been since 2004, when John Kelly, MD, founded the ACLM at Loma Linda University? As the university's Lifestyle Medicine Residency Program brochure reads, "Nutrition, physical activity, rest. Becoming a national expert at prescribing these natural methods of preventing and treating disease to individuals and to communities is what Loma Linda University's Lifestyle Medicine Track is all about."
In an article on the ACLM's website in June 2014, Dr. Kelly stated: "Every major advance in science or medicine seems to involve years of pioneering work by those with passion and conviction about the need for change, followed by a quantum leap forward. The formation of the American College of Lifestyle Medicine in early 2004 illustrates this phenomenon."
He went on to say: "The body of published evidence for the superior effectiveness of lifestyle interventions in the treatment of chronic disease reached a tipping point ... in view of such overwhelming evidence it became obvious this new medical treatment needed to be available to the millions of patients who were dying without it."2
But Here's the Rub
Dr. Kelly's comments are quite moving; in fact, as a chiropractor you might even be interested in getting involved with this type of health care movement. But there's only one problem: you can't! If you go to the ACLM's website and try to become a full-rights member, you'll find membership is limited. If you want to become a Doctoral Level Member, you must have an MD or DO degree. If you want to join as a chiropractor (remember the Wilk case), you can, but only at the Professional Doctoral Level, alongside psychologists, naturopaths, pharmacists and dentists. No big deal? I'm not totally convinced.
Harvard Med. School Weighs In
Besides the ACLM at Loma Linda University, Harvard Medical School has gotten on board with the movement via its Institute of Lifestyle Medicine. On the institute's website, it states: "The Institute of Lifestyle Medicine (ILM) was founded in 2007 at Spaulding Rehabilitation Hospital and Harvard Medical School to reduce lifestyle-related death and disease in society through clinician-directed interventions with patients. A non-profit professional education, research, and advocacy organization, the ILM is uniquely positioned to ignite clinician involvement in lifestyle medicine."3
The website also lists a number of continuing-medical-education courses that are available, including "Lifestyle Medicine 2015: Tools for Promoting Healthy Change." The course description is as follows:
"This two-day course offers state-of-the-art strategies to guide patients to healthier lives. Education includes evidence-based tools and techniques for effecting healthy changes in diet, physical activity, sleep, weight loss, and stress management. This course also provides updates on payment structures that reward clinicians based upon patients' health behaviors and health outcomes. Ranked among the highest-rated Harvard Medical School CME courses, past participants report a renewed passion for practicing medicine and reduced personal stress as they themselves learn to enhance their own health and serve as role models for their patients."
Did you get that? This program is the highest-rated CME course Harvard Medical School offers.
Lifestyle Medicine for Back Pain?
If you're not concerned yet, how about this Harvard CME course: "Lifestyle Medicine – Acute Low Back Pain." As the course description explains, "This course will help physicians manage acute episodes of back pain. The content provides simple tools to use to help influence patient recovery. By reviewing lifestyle factors that influence back pain, the course enables physicians to provide advice and recommendations that will allow patients to recover from their acute back pain episode and to make informed decisions about their behaviors and lifestyle factors related to back pain."
I wonder if one of the "informed decisions" they'll help patients make is to avoid chiropractic care.
Need to Hear More?
OK, have you heard enough? Well, let me bring up just one more important point: Our government and national insurance companies are getting involved. On June 24, 2014, the PRNewswire and USNewswire reported a headline that read: "All Medical Students and Physicians Need Training in Nutrition and Physical Activity to Help Combat America's Obesity Epidemic, Urges New Paper by Bipartisan Policy Center, American College of Sports Medicine and Alliance for a Healthier Generation." The article went on to say, "More than 75 percent of physicians said they received inadequate training in this area." In other words, medical students and physicians are recognizing an opportunity exists to provide wellness care to their patients with the proper training.
Lifestyle Medicine Does Fill a Niche
Enough paranoia; let's get down to brass tacks! At worst, medicine is trying to own the wellness care market, but at best, it's filling a much-needed niche. We chiropractors somehow think the wellness movement belongs to us, but we're likely to wake up someday and find we are on the outside, looking in. What are the facts driving this huge medical and government push?
The Centers for Disease Control and Prevention (CDC) has stated that seven of 10 deaths and 75 percent of the total health care costs in the U.S. are due to chronic diseases. Nearly one of every two Americans has at least one chronic disease. Almost 90 percent of heart attacks and strokes are due to preventable causes. The CDC has the following statement posted on its Chronic Disease Prevention and Health Promotion website: "Four modifiable health risk behaviors, lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption, are responsible for much of the illness, suffering, and early death related to chronic diseases."4
We Need to Take Action
I'm not sure how much lifestyle education and training you have or how much lifestyle coaching you are currently doing in your practice, but I hope I've given you something to think about. In my next two articles in DC, I will explore the two biggest clinical challenges chiropractors face and must be prepared to treat if they expect to compete in the wellness care marketplace; plus what they must do to prevent losing most of the back pain market.
And in my fourth article, to be published in DC Practice Insights, I'll delve into the opportunity each of us has to expand our practice and grow our patient base if we embrace our chiropractic education and heritage, step up to the plate in the field of lifestyle wellness, and help patients understand how to modify those leading health risk behaviors.
Editor's Note: As Dr. Hayes mentions, this is the first of four articles on the challenge / opportunity for DCs to compete in the wellness care marketplace. Articles #1-3 run in Dynamic Chiropractic, while article #4 appears in DC Practice Insights. Articles will run in consecutive issues, with part 2 running in the May 15 DC, and parts 3 and 4 appearing in the June 1 and June 15 issues of DC and DC Practice Insights, respectively.
- "What Is Lifestyle Medicine?" American College of Lifestyle Medicine.
- Kelly J. "The Beginnings of the American College of Lifestyle Medicine. American College of Lifestyle Medicine, June 2014.
- "About the ILM." Harvard Medical School, Institute of Lifestyle Medicine.
- "Chronic Disease Prevention and Health Promotion: Overview." Centers for Disease Control and Prevention.
Dr. Donald L. Hayes, DC is a clinician, educator and author of several books, including Lifestyle Wellness and, along with Michael E. Gerber, The E-Myth Nutritionist: Why Most Healthcare Practices Don't Work and What to Do About It. He is founder and president of the Greens First line of nutritional products and the Lifestyle Wellness Total Health Improvement Program. He can be reached at 866-410-1818 or through www.greensfirst.com.