Drugging Our Children
“Take two pills and call me in the morning,” seems to be the new wave of medical care within the United States, and this applies to children as much as it does adults. Increasingly, children are being put on antidepressants and psychostimulant medications for attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and related ailments. More than 10 million children and teens took antidepressants in 2002, according to the US Food and Drug Administration (FDA), and according to a 2002 report by the US Centers for Disease Control and Prevention, more than 3.5% of school-age children are diagnosed with ADHD. More than half take psychostimulant medication.

According to new research, however, there are alternatives. “Chiropractic care simply reduces pain throughout the body,” says David Latch, DC, of San Francisco.

One such study, which appears in the journal Pediatrics, found that teens reporting physical symptoms with unknown causes faced the possibility of panic attacks and major depression. There are many underlining causes of a particular ailment, such as depression and ADHD, according to Bobby Doscher, DC, CEO of Oklahaven Children’s Chiropractic Center, Oklahoma City. “It’s the body that is weak, not the child himself,” says Doscher. “ADD and ADHD is a sensory shutdown of the human body. We need to bring the power back so the body can get strong enough to function properly.”

The attention toward the use of psychostimulants to treat ADD and ADHD and whether these drugs are being overused or underused creates much debate, according to Richard Scheffler, University California Berkeley professor of health economics and public policy and principal investigator of a $900,000 grant to study the use of such drugs in children. More attention may mean that these untreated disorders are not only being diagnosed, but treated. However, there is risk in using any type of medication.

Several states have enacted laws limiting the extent to which schools can encourage parents to put their children on psychostimulants. Britain last summer prohibited the use of selective serotonin reuptake inhibitor’s (SSRI) for depression in children because of an increase in suicidal behavior and potential self-harm. In March, the FDA issued a Public Health Advisory cautioning the use of antidepressants in adults and children. Although its antidepressant studies have not yet clarified whether or not such drugs contribute to the emergence of suicidal thinking and behavior, the FDA is advising physicians and parents to closely monitor those being placed on therapy with these drugs.

Safer alternatives, such as chiropractic care, should first be sought out, according to Doscher. “We must look at [children] as spiritual beings,” says Doscher, “not packaged goods.”

AAP Releases New Ear Infection Guidelines

New conservative guidelines for treating children with ear inflammation was recently released by the American Academy of Pediatrics (AAP). The AAP guidelines indicate that, because at least 75% of silent ear infections clear up on their own within 3 months, watchful waiting is the preferred method of handling the condition, with medical intervention recommended for only those cases that persist for more than 3 months. The American Chiropractic Association (ACA) agrees with the new guidelines, but recommends manual therapy before drugs or surgery. “Particularly when dealing with young children, drugs and surgery should be an absolute last resort,” says ACA President Donald Krippendorf, DC. “Doctors of chiropractic have been treating children for decades with great success, helping them avoid painful ear infections, antibiotic overuse and resistance, and ear-tube surgery.”

ACA Appeals Recent Decision to Dismiss Trigon Case

The May 6 decision by the US Court of Appeals for the 4th Circuit to dismiss the case against Trigon Blue Cross Blue Shield has prepared the American Chiropractic Association (ACA) for a fight. The ACA announced on May 12 that it has taken this action as a precursor to petitioning at the highest level, the US Supreme Court, if necessary. “If the nation’s antitrust laws mean anything at all, the ACA has absolutely no choice but to continue to pursue this case and ensure that this decision is overturned,” says ACA President Donald J. Krippendorf, DC. “Every patient who has been denied a proper referral to a chiropractor for musculoskeletal problems and has had to endure unnecessary pain, surgery, drugs, and their side effects or disablement from work or social activities is a silent witness to this lawsuit. We owe it to them—our patients—to fight this battle with every ounce of legal strength we can muster.” Through its lawsuit against Trigon, which addresses what ACA believes to be discriminatory reimbursement practices against doctors of chiropractic, ACA alleges antitrust violations, citing Trigon’s decision to pay doctors of chiropractic 40% less than what it pays medical doctors for identical services, block referrals to doctors of chiropractic, inappropriately reduce codes, and establish discriminatory limits and caps. ACA also seeks to make manual manipulation of the spine to correct a subluxation as a chiropractic-only service. A key piece of evidence in ACA’s case was the existence of a committee established by Trigon to review low-back guidelines published in 1994 by the federal government’s Agency for Health Care Policy and Research (AHCPR), guidelines favorable to chiropractic, and to recommend appropriate protocols for referring patients to chiropractic doctors. The committee was appointed from a pool of representatives recommended by medical specialty associations from Virginia. No chiropractors were appointed to the committee and no chiropractic associations in Virginia were given the opportunity to submit names of nominees to the committee. As a result, the committee published guidelines that did not mention the positive effects of spinal manipulation that had been a highlight of the AHCPR report. According to the ACA, the committee instead diminished spinal manipulation’s value, and in doing so, invalidated a legitimate federal study. The Court of Appeals found that the committee was an agent of Trigon, not a separate entity, and therefore no conspiracy existed. Instead, the court likened Trigon’s actions to a hospital’s credentialing “peer review” process. However, not all is lost. More Americans now have greater access to chiropractic care and millions of additional dollars are being reimbursed for chiropractic care as a result of ACA’s legal action. ACA and the National Blue Cross Blue Shield (BCBS) Association have begun to improve chiropractic recognition and coverage in BCBS plans nationwide. A new chiropractic benefit worth approximately $120 million to $140 million per year in the Federal Employee Health Benefits plan administered by BCBS is one benefit from ACA’s legal action. Another outcome of the Trigon case is the launching of the Blue CCHip program (Blues/Chiropractic Clinical Healthplan Program), a liaison program that has allowed doctors of chiropractic to become integrated into local BCBS medical policy-making committees across the country. “These victories did not come by accident,” says Krippendorf. “They are substantial benefits derived from the support we’ve received from so many in our profession who want what is best for chiropractic. We’ve received assistance in our legal battles from all corners of our profession because we’re doing the right thing. We remain dedicated to protecting the rights of doctors of chiropractic.”

Alternative Care On the Rise
Thirty-six percent of Americans are incorporating complementary and alternative medicines (CAM) into their health care regimen, according to a recent government survey released by the National Center for Complementary and Alternative Medicine (NCCAM). The reason why may be surprising. Nearly 28% of respondents, according to the survey, indicated they chose to seek CAM therapies because they believed that conventional medicine would not help their health care problems.

The survey also showed that chiropractic patients may have less confidence in traditional medical care than those who had sought CAM therapies. Nearly 40% of chiropractic patients indicated they felt conventional medicine could not help their condition. “It may be the public is turning to complementary and alternative medicine because it’s not getting relief from conventional medicine,” says Richard Nahim, DC, NCCAM’s senior advisor for scientific coordination and outreach.

Chiropractic care was also shown to be the most highly sought manipulative and body-based therapy included in the survey. “This new CAM survey is promising,” says Donald Krippendorf, DC, American Chiropractic Association (ACA) president. “For years, the ACA has advocated restraint against the use of excessive drugs and unnecessary surgeries, as safer, more conservative, and more effective options exist.”