As the United States prepares to enter the next millennium, chiropractic physicians face a unique set of professional challenges. Challenges identified by the New Millennium Chiropractor report by the Trends Research Institute [J/F, 1998] include managed care, political positioning and public image. While these issues are significant, they are not insurmountable. Opportunities exist that can allow chiropractic physicians to establish themselves as the leaders of the health care industry for the 21st Century. One such opportunity is the development of a chiropractic practice as a wellness center for the community.
The benefits of such an approach seem obvious:
I. Increased patient base
There is an old adage, “If you look after your patients, your practice will look after itself.” However, contemporary economic challenges threaten the vitality of the provider-patient relationship. In other words, “If you don’t look after the practice, there may be no patients to look after at all.” Studies show the American public is interested in alternatives to conventional medicine. According to the New England Journal of Medicine, approximately $14 billion dollars are spent each year on alternative or complementary therapies. The nutritional supplement industry alone accounts for more than $6 billion of this amount. The vast majority of costs associated with complementary approaches are not reimbursable, suggesting patients are more interested in achieving good health than in evaluating the price tag that may come with it. As a community wellness center, you will be providing a much-valued service. Your decision to develop a wellness program within your practice demonstrates your commitment to provide the very best.
II. Enhanced professional credibility
Although most health professionals enter the field because of a desire to help others achieve optimal health, at times, those who do not fully appreciate the value of chiropractic may question motivations, fee schedules, and follow-up requirements. The incorporation of a comprehensive wellness center will showcase the chiropractor’s commitment to the health of their patients.
III. Better utilization of skills and knowledge
As a wellness professional, the chiropractic physician has an opportunity to provide comprehensive health care. Patients will look to the wellness center to help them address weight management issues, osteoporosis, osteoarthritis, immune disorders, cardiovascular issues as well as other health concerns. An added sense of fulfillment is possible for those chiropractors who fully utilize their experience and expertise.
IV. Additional profit center.
The expansion of scope of services a wellness center provides can serve as an additional source of much-needed revenue for the practice. For example, sale of adjunctive products as nutritional supplements and educational materials and tools may result in substantial income opportunities for the professional.
Develop a wellness center in the modern health practice
A number of programs exist which purport to result in a wellness center in the modern health practice. Few are comprehensive in their approach and all should be viewed with skepticism. A successful wellness center should include all of the following components.
Quality nutritional products
The role of nutrition in health and disease is no longer in question. What remains questionable is the purity, potency, and, ultimately, the efficacy of many nutritional supplements. Few people realize the nutritional supplement industry is not under the purview of the Food and Drug Administration (FDA). In fact, few regulatory standards exist for nutritional supplements. Therefore, it is imperative the chiropractic physician knows that the products recommended are of the highest purity and potency. Remember the tryptophan scare of a decade ago? A contaminated batch of tryptophan was included in a series of nutritional supplements. The effects were devastatingsome consumers developed rare blood disorders and, ultimately, the nutrient was banned from sale. In reality, nothing was particularly dangerous about tryptophan, but slack quality control procedures, a far too common reality in the nutritional supplement industry, allowed innocent individuals, as well as the professionals who recommended the nutrient, to experience increased risk. One way of ensuring quality control is to only affiliate with companies whose manufacturers elect to be licensed by the FDA. These facilities must meet or exceed the stringent protocols and Good Manufacturing Practices established for the pharmaceutical industry. In addition, it is desirable for the products to be subjected to rigorous disintegration and dissolution testing. The best-formulated product in the world is of little benefit if it cannot be made available for absorption at the cellular level.
Five other factors to consider include:
1. Processing techniques.
It is well known that heat destroys many nutrients, particularly enzymes. Supplement manufacturers should guarantee all products are formulated in the cooler temperature ranges that preserve nutritional potency.
2. Use of chemical solvents.
Although commonly utilized in both the nutritional supplement and pharmaceutical industries, some chemical solvents are mutagenic. There is little logic in recommending a product to enhance or preserve health if it is also a known carcinogen. Chiropractic physicians should question manufacturers as to whether chemical solvents are used in the processing of their nutritional supplements.
3. Supplement coatings and binders
A commonly used tablet coating in the nutritional supplement industry is pharmaceutical grade food glaze, better known as “shellac.” One advantage of shellac coating on a supplement is it yields an attractive shiny appearance and renders the pills slightly slippery, which may facilitate swallowing. However, this coating often results in the phenomenon known as “bedpan pills,” products which transverse the gastrointestinal tract intact. Similarly, ethyl cellulose is an agent commonly used to “bind” nutritional formulations to facilitate the manufacturing process. In fact, ethyl cellulose is a binder so effective, the nutrients it coats can be rendered unavailable for absorption. A safer alternative is to identify those products coated with a solution of water and vegetable proteins. This process allows for maximum disintegration and dispersion. Chemical binding agents are never necessary.
4. Beware of products that are penny wise and pound foolish
Just as all nutritional supplements are not created equally, neither are the nutrients themselves. Wide disparity exists among the safety and effectiveness of specific nutrients. For example, selenium is a trace mineral that is shown to be effective in the prevention and treatment of many cancers. It is interesting to note that selenium may be derived from more than one source. One such source is sodium selenite, the inorganic form of selenium. However, it has a lower toxicity threshold than other forms of selenium and is rendered useless in the presence of vitamin C.
L-selenomethionine, on the other hand, is the organic form of selenium. It possesses a relatively high threshold for toxicity and retains its beneficial actions even in the presence of vitamin C. L-selenomethionine is significantly more expensive that sodium selenite, but it is also significantly safer and more effective. Which form is most commonly included in nutritional supplements? The less expensive, less effective and higher risk form, sodium selenite. Wellness professionals should be extremely wary of any nutritional supplement that seems to have been designed by the company accountant rather than by those familiar with the scientific literature.
5. An open door policy
Does the company actually manufacture the products or are they simply a marketing company? If the answer is the latter, that company may have little or no control over the quality of the products or the methods used to produce them. If the company is also the manufacturer, do they fully disclose their policies and procedures and invite you to tour their facility? If a supplement manufacturer does not allow you to personally inspect their facility, perhaps it’s because they have something to hide. The wellness professional is well advised to investigate thoroughly the company that produces the products to be recommended to patients.
A wellness approach to weight loss must include appropriate educational tools that teach patients how to adopt a low-fat diet, read and interpret food labels, decipher restaurant menu terminology, and prepare delicious and healthy meals. In addition, patients must be made to understand the importance of water intake, as well as that of a consistent exercise regimen. Because individuals learn in a variety of ways, educational materials in a variety of formats should be available. At a minimum, information should be provided in audio, videotape, and printed forms.
Every health professional understands the challenges of remaining current with the scientific advances in their particular specialty. Many chiropractic physicians have expressed frustration that there never seems to be enough time to read and absorb all of the relevant information in professional journals or to attend appropriate meetings. While most chiropractic education includes information on nutrition, the curricula are unclearly defined and unsystematically approached by chiropractic schools. Even recent graduates from chiropractic colleges are likely to be unaware of the current state-of-the-art information in clinical nutrition. However, there are helpful sources of current nutritional information available. Please refer to Figure One on this page.
A comprehensive approach
No two patients are alike. Each brings with them a complex series of physical, environmental, emotional, and behavioral idiosyncrasies that play a role in their treatment and recovery. Similarly, no one wellness protocol will be appropriate for all individuals. Although national surveys indicate that all Americans are deficient in a number of essential nutrients, some patients may have a weight management agenda, others may be experiencing cardiovascular concerns, and still others wish to improve their athletic performance. A successful wellness program should be capable of addressing each of these concerns.
However, a particularly complex approach is equally undesirable. Studies show that compliance with a recommended regimen is inversely related to its intricacy. Anecdotal evidence suggests that a “kit” methodology that may be customized to the unique needs of the individual is more effective than either the “one-size-fits-all” or “plethora of products” approach.
A customized approach
Just as no two patients are exactly the same, neither are any two clinical practices. The ideal implementation model should consist of a “menu” of options the professional can best customize a program to best fit the unique concerns of his or her individual practice. Under no circumstance should the practice be required to adapt to the wellness component. Rather, the wellness program should be able to be adapted to the practice with consistent and duplicable success.
Facing the challenges
By establishing their practices as wellness centers for their communities, chiropractic professionals may not only be the best hope for the nation’s health, but also effectively address the professional challenges they will face with the new millennium. A well-planned, comprehensive wellness center within the chiropractic practice may offset declining revenues imposed by managed care. Furthermore, as a wellness leader for the community, chiropractic physicians can increase their desirability to the American public which may, in turn, improve their political positioning. Chiropractors as the 21st Century wellness leaders are well poised to revolutionize modern wellness care in the United States.
What Are The Risks
It is important to note the risks associated with the implementation of an incomplete/ineffective program may be more subtle.
1. More knowledgeable patients
Patients are increasingly better educated about complementary approaches to disease and health care. Nutrition information is no longer restricted to scientific journals. Consumers are learning about specific nutrients and processing techniques from widely disseminated newsletters, magazines, and television reports. The internet is a commonly used resource for health information.
2. Increased skepticism
Patients are increasingly suspicious of anyone or anything they feel is not in their best interests. They want to consult with a practitioner who will openly and actively work with them to achieve enhanced health and wellness. Furthermore, patients want to be confident that their health care providers have researched the quality and value of the products and procedures in their practices.
Where can you find nutritional information?
There has been an explosion in the clinical literature on this topic in recent years. Between 1994 and 1998, more than 18,500 scientific abstracts relating to clinical nutrition were included in Medline, the on-line reference service of the National Library of Medicine. However, many wellness professionals have an affiliation with organizations that provide a comprehensive database of nutrition information.
I have found one of the most useful of these is available in a CD-ROM format and adaptable to either a Windows or Macintosh platform. The database includes more than 10,000 pages of information categorized as follows:
- Health Conditions
- Amino acids
- Nutritional Supplements
The CD-ROM includes easy search capabilities and all of the information included in the database may be printed and provided to the patient as an educational tool. A particularly useful feature of the CD-ROM is its link to an internet web site which posts updated information on clinical nutrition as it becomes available. Please contact the author for information on how to obtain a copy of the CD-ROM.