Where will the chiropractic scope of practice settle as COVID, opioids, seniors, and America’s overweight force health care changes?
The COVID-19 pandemic is reshaping U.S. health care and patients are increasingly taking their health into their own hands moving forward. The most overweight country in the world, America has been devastated by the virus that preys on the overweight and excess inflammation, and the result has been a growing focus on a population in need of a fitness intervention. How should this impact the chiropractic scope of practice in the U.S.?
Likewise, the U.S.’s burgeoning senior population is more active than in past years and looking to live longer, move better, and avoid falls and injuries that claim an ever-growing percentage of the 65-and-over set. All the while the opioid epidemic has been overshadowed during COVID-19, but has far from gone away.
Chiropractic scope of practice: wellness first?
With regular chiropractic care the body has the ability to heal itself, and patients are seeing DCs as a first line of defense for non-surgical and drug-free approaches. If there was ever a time for wellness chiropractic in concert with natural medicine and a holistic view of care to gain widespread popularity, that time is now.
While many brick-and-mortar health retail businesses have suffered during COVID-19, online or in-store supplement sales have been through the roof, a testament to Americans looking to strengthen their immune systems and overall health.
The health chain GNC, due to COVID-19 market effects, recently announced the closing of up to 1,200 of its stores across the U.S. This is another opportunity for the expanding chiropractic scope of practice and doctors of chiropractic who consult their patients on nutrition and staying virus-free with higher-level supplements that cannot be found in stores.
“The immunity category is the major growth sector, with a halo effect in other categories, with mushrooms and probiotics as examples,” says Loren Israelsen, president of the United Natural Products Alliance, speaking to Nutrition Industry Executive magazine. “Sports nutrition has been slow, which is understandable as gyms and many athletic activities were put on hold. This should rebound as the economy reopens, at whatever pace.”
DCs who are not partnered with a scientifically-validated nutrition company can easily reach out to companies that offer free evaluations of service, have patient bases, and can recommend personalized supplement lines to take advantage of what many are calling a health shift rather than a trend.
“As one would expect, the sales of scientifically-validated nutrients that support proper human immune function have been extraordinary, and there is no sign that the demand is subsiding,” says Mark LeDoux, CEO and chairman of Natural Alternatives International, speaking to Nutrition Industry Executive magazine. “For example, vitamins C, D and zinc with other components, such as beta glucan and herbal extracts, have been flying off the shelves — and our prediction is that this will continue to be the case for the balance of 2020.”
Health trend or major shift?
One industry company, according to the publication, sold a year’s worth of one of their product lines in March alone, and industry reports point to consumers staying with their new products and supplements going forward.
“These consumers came in, they’re satisfied with the products, they’re going to stay,” says Michael McGuffin, president of the American Herbal Products Association. “We will, at the end of all of this, have expanded the consumer base for herbal products, natural products and supplement products.”
Health care industry executives see patients adapting now to better prepare for “next time,” with older patients improving their health through supplementation to defend against flu-like viruses. Younger patients and the next generations are seeking greater health through supplementation, technology (smart watches and bands providing bio-feedback), and a greater openness to alternative solutions to reach their health goals.
It’s not the disease, it’s the host
Statistics show that Americans, by and large, do not take care of themselves.
On top of poor nutrition, pile on stress from COVID-19 (job loss, kids at home, general anxiety, etc.), existing possible comorbidities (hypertension, asthma, disease, other illness), and environmental hazardous microbes and toxins, and you have humans primed to receive viruses.
Instead of focusing strictly on the disease, chiropractors and health care practitioners in 2020 need to focus on how viruses such as COVID-19 interact with hosts, and a chiropractic scope of practice regarding how to create or maintain the healthiest of hosts.
“The virus didn’t produce the disease. The virus had to do with the interaction with the host, and the reaction goes back to their resilience,” said Jeffrey Bland, PhD, FACN, FACB, during the virtual 2020 Institute for Functional Medicine Annual International Conference. “All disease is a result of disordered function. We must focus on restoring disordered functions to order.”
Along the lines of overall wellness, Bland says genes, an individual’s environment, lifestyle, and diet all come into play, and all but genes can be examined and modified by doctors of chiropractic, MDs and patients.
“There is a dynamic relationship between the individual and their environment,” Bland said. “When treating these pandemics, what we’re talking about is how we can pre-regulate immune resilience, the innate and adaptive immune system balance, to produce a proper outcome.”
Prevention is being redefined, says Bland, as part of a resiliency story that includes practitioners examining the lifestyle, nutrition and environment of patients to regulate disease risk via prevention.
“Resilience is the way we quantify prevention in the individual which is related to their function,” Bland says. “These are powerful changes that will occur.”
The opioid epidemic — not gone, not forgotten
In the midst of COVID-19, as America eased into the first of the summer months, opioid prescription and overdose numbers reminded the health care community that the industry’s issue with prescription painkillers was still prevalent.
“Doctors and other health care providers still prescribe highly addictive pain medications at rates widely considered unsafe,” wrote Brian Mann for NPR in July after the outlet completed an investigation. “Critics say the practice exposes tens of millions of patients each year to unnecessary risk of addiction, overdose and death.”
The investigation, which included public data, including new government studies and reports in medical literature, showed that currently “enough prescriptions are being written each year for half of all Americans to have one” and that “doctors and dentists are still flooding the U.S. with opioid prescriptions.”
Some statistics according to NPR:
- The U.S., at 5% of the world population, continues to consume 80% of the world’s prescription opioids;
- In 2018, the last year for which complete data is available, more than 1 in 5 Americans had an opioid prescription filled;
- In 2018, roughly 40 Americans died each day from taking prescription opioids;
- Over the past decade, pharmaceutical companies have spent more than $880 million lobbying for opioid-friendly regulations;
- A CDC study released in May of this year found many physicians regularly ignore federal guidelines and still prescribe large quantities of opioids;
- Opioid prescriptions by dentists have increased, and dentists are now the primary prescribers of opioids to adolescents and young adults.
“We’ve had an attitude about opioids that they are similar to antibiotics, where you can prescribe and forget. That’s a crazy view for a medicine like opioids,” said Travis Rieder, a bioethicist at Johns Hopkins University who himself struggled with opioid dependence, speaking to NPR. “I’d just call the surgeon, and he’d up the dose. They kept writing the prescriptions, and I kept taking them.”
Roughly half the states have implemented regulations curbing opioid prescriptions after the CDC issued warnings and guidelines that included alternative care first, such as chiropractic. The patient base is huge, as an estimated 10 million Americans received high opioid doses and currently remain addicted.
The ever-growing senior population
Young chiropractors today exiting DC schools will see approximately twice the number of age 65-and-older patients as chiropractors in the past. The Population Reference Bureau reports the elderly population will double to 95 million in the U.S. by 2060, making up almost 25% of the overall population.
The current senior population, living longer and more actively than previous generations, is already a subset served or specialized in by many in their chiropractic scope of practice. In regard to health, longevity, and other quality-of-life aspects such as maintaining overall fitness, flexibility and balance, this is key for the exploding senior population and for DC new patient streams.
Balance and falling remains a critical issue for seniors where chiropractic plays a major role. Of seniors 65 and over, 20% of seniors who fall experience a serious injury, according to the CDC, with more than 800,000 hospitalized each year due to hip fractures and fall-related head injuries. Over roughly the last 15 years the heightened activity levels of seniors has resulted in death rates from experiencing falls rising to 30%.
Compounding the issue is less than half of seniors telling their health care providers or being open about falling. A challenge for chiropractors is getting elderly patients to open up about issues such as falling that they may be embarrassed about, providing regular chiropractic care, and working with them on balance issues designed to improve stability while walking, standing and sitting.
‘Active and adaptive’ campaign
A marketing campaign to help kick off outreach to your older patient base will be provided in October during National Chiropractic Health Month, when the American Chiropractic Association (ACA) unveils “Active and Adaptive.”
“After months of sheltering in place, many people are still practicing lifestyle changes to reduce their potential exposure to the novel coronavirus,” the ACA says. “As a result, people are moving less, feeling less fit and, in some cases, experiencing pain. National Chiropractic Health Month 2020 will encourage the public to adjust to the challenges of staying fit and pain-free within a smaller lifestyle footprint by becoming more mindful of movement and posture and by highlighting tips and strategies to help them adapt in healthy ways.”
An “Active and Adaptive” campaign toolkit, with resources and ideas on how to participate, will be available in September at acatoday.org/NCHM.
Chiropractic scope of practice: the future of DCs in health care
Nutrition, weight loss, immunity building, senior care and a still-dangerous opioid epidemic are all opportunities for doctors of chiropractic to expand services and provide holistic health care and wellness services for communities in need.
“More consumers will be open to physical therapy and chiropractors to avoid the risk of complications and stay out of hospitals or operating rooms,” wrote MedCity News last month. Many conditions have treatment alternatives…and often consumers aren’t even aware of or incented to use lower-cost, less invasive alternatives.”
Billy Tauzin, former Republican congressman from Louisiana and former president of PhRMA, told StatNews regarding the impending doctor shortage, “Family doctors are becoming more scarce and hospitals in parts of our country are shutting down. That’s going to be a major shift to decentralize health care, and toward preventive care and home care.”
As health care is reshaped over the next 6-8 months between COVID and political pressure, it will be up to doctors of chiropractic and supporting state and national associations as to whether chiropractic steps up to offer patients more services, or settles for its traditional “alternative care” role.
RICK VACH is editor-in-chief of Chiropractic Economics. Letters to the editor can be sent to firstname.lastname@example.org.