My meeting on April 10, with Rep. Austin Scott, R-Ga., could not have been more shocking or disappointing. I met with him to ask for an investigation into the boycott of chiropractic services at Robins Air Force Base for active military in TRICARE as well as injured civilians in federal workers comp program. Over my 35-year career, I have never had any referral from the base nor have any doctors of chiropractic in Middle Georgia.
From the beginning, I felt a hostile vibe upon meeting Rep. Scott, starting with his dead-fish handshake to his body language, slouching in his chair while looking at me out of the corner of his eye. He seemed disinterested and detached, certainly not the Southern hospitality I expected.
I prepared a 30-page dossier concerning the history of my correspondence with the base, including the TRICARE law signed by former President George Bush calling for RAFB to implement the chiropractic provision by Sept. 30, 2006. RAFB has still failed to do so.
In fact, of the 59 Air Force bases in the U.S., only 20 have chiropractors on staff although all bases were required to do so by law.
I also produced a Freedom of Information Act request for fiscal year 2012 that showed that of the 2,512 spine-related injuries at RAFB in its federal workers comp program, not one was referred to any chiropractor. I also mentioned the BRAC analysis showing RAFB ranked as the highest cost among workers comp patients of the five air logistic centers, making Macon the back surgery capital of Georgia per capita.
I also shared with him the recent American College of Physicians updated guidelines on lower back pain that call for conservative care for first-line treatments, but he didn’t seem interested, never touching the handouts I brought.
It quickly became apparent that Scott was unfamiliar with the dossier on these issues I gave to his legislative aide, Cameron Bishop, at his Washington office in mid-March when I visited the Capitol. Assuming maybe he had not seen it, I brought another one but he never looked at it.
I spoke of the high rates of opioids, epidural shots and the failure rate of lumbar spine fusions that have sparked growing concerns in the media, but he still seemed uninterested. I also mentioned the Mayo Clinic systematic review of MRI exams of asymptomatic patients that found “bad discs” in pain free people, as well as other pertinent bits of evidence in the paradigm shift in spine care. But again, he didn’t want to see the actual information.
None of this new data fazed this Republican representative. He never opened the dossier; he never looked at the new guidelines from the ACP. He was totally uninterested in my dossier information. I also pointed out to him that all three Army posts in Georgia (Benning, Stewart and Gordon) already have DCs on staff, but he seemed to withdraw even more.
Finally he spoke, “Well, if the laws allow for it, then they should follow it,” he replied rather reluctantly.
“But that’s my point: the laws call for chiropractic care but the base has stone-walled this issue for years as my dossier correspondence material proves.” For that matter, Scott also failed to respond to my letter of Jan. 20, 2011, concerning Department of Defense discrimination against chiropractic care. Two years ago I met with his legislative aide in Washington about this matter, but again never got a response.
I mentioned that some surgeons scare people into unnecessary spine fusion based on “bad discs.” “If you don’t have my surgery you’ll be paralyzed and if you go to a chiropractor, he may paralyze you.”
If I had a nickel for every time I’ve heard that lie, I could retire. Indeed, the “bad disc” diagnosis is the red herring that has led to thousands of unnecessary spine surgeries as the Mayo experts suggest. I actually had the Mayo Clinic chart showing “bad discs” in pain-free adults, but Scott never looked at it.
This research is why the ACP issued new guidelines because there is too much abuse of opioids, epidurals and spine surgery. Rep. Scott then blurted out, “There are good chiropractors and bad ones,” apparently as justification for his negative attitude toward chiropractors.
I replied, “And there are good orthopedists and bad ones.” I could not believe this petty bickering with my U.S. representative.
I asked Scott if he knew anyone who has had a positive outcome from spine fusions, which seemed to annoy him. Again, he simply looked at me with a stern look, and then said, “Yes, I know many, many, many people who have successful back surgeries.”
“Well, you must be exceptional considering one study found 75 percent of spine fusions failed to return patients to work after two years, and most are still taking opioids.” Plus, every guideline on low back pain discourages surgery unless conservative care fails to help.
My comment awakened him from his look of boredom and then he blurted out, “I think you’re prejudice against orthopedic surgeons.”
I was shocked and could only feel this is the pot calling the kettle black. Anyone halfway familiar with the medical war against chiropractors knows his comment is foolish. “Not at all, but I am prejudiced against unnecessary opioids, epidurals and spine fusions.”
Then the truth came out: “You should have done your homework to realize my dad is an orthopedist,” he said. Little did I know his father is an orthopedic surgeon. Finally I understood his resentment towards me. His bias could no longer be contained, but I wanted to redirect the conversation back to the issues.
“This isn’t about your dad or orthopedic surgeons; it’s about RAFB following the law to offer active military members access to chiropractors and allowing injured civilian workers the right to choose chiropractic care in workers comp as the laws allow.”
Once again he made another inaccurate account of my presentation, “You made a blanket condemnation of all orthopedic surgeons.”
I turned to his assistant who was taking notes and asked, “Did I ever say that?” knowing full well I had not. He didn’t say a word.
“I am talking about unnecessary spine surgery done before conservative care is first used, just as the guidelines recommend.”
I pointed to my books, “I have all that information in my books if you’re interested,” but it was obvious he had the attitude. His mind was made up with medical prejudice ingrained from a lifetime of medical misinformation, no doubt, from his father.
He seemed very mad by now, refusing to be swayed by the laws, the evidence, or my plea that RAFB must follow the law. Obviously this meeting was going nowhere fast. He also said he would not call for an investigation into this matter. As far as he is concerned, there is no need to determine if RAFB is following the law or not about chiropractic care.
Finally, as he and his staffer were almost pushing me out the door, with his eyes shooting darts at me, he warned, “the next time you meet with somebody, you should be nicer.”
Once again I turned to his aide and asked, “When was I not nice?”
I never raised my voice although I did bite my tongue a lot. I did correct his misstatements and corrected his embellishments about what I had said. I replied to his snide remark, “I expected you to take this information professionally, not personally.”
After all, he’s the public servant, not me.
Obviously blood is thicker than water, especially when it comes to an orthopedist’s son and a chiropractor.
J.C. Smith is a doctor of chiropractic practicing in Warner Robins.