Integrative physician David Borenstein, M.D., is a New York City-based integrative doctor who focuses on thyroid and hormone balance, hormone health, weight loss and other complex endocrine issues. He has followed the issue of chiropractors targeting chronic disease patients for testing and nutritional programs. Dr. Borenstein also has some thoughts about chiropractors branching into disease diagnosis and treatment. He is interviewed by Mary Shomon, Guide of this site.Mary Shomon: "As you are aware that there is an increasing focus by a subset of chiropractors to depart from traditional chiropractic practice -- which focuses on neck and back pain -- and instead focus on disease diagnosis and management? In particular, some chiropractors are selling each other marketing programs that teach how to promote and sell costly thyroid testing and treatment programs to chronically ill patients, getting them to pay upfront fees -- in the $10,000 to $15,000 range -- by cash or credit card. What do you think is driving this shift by chiropractors from their own area of expertise to diagnosis and treatment, which is more appropriately done by physicians?"
Dr. Borenstein: "Unfortunately, this pattern that has emerged among the subset of chiropractors you describe here is driven by the declining rates of reimbursement from insurance companies for standardized chiropractic care. In addition, there is an increasing level of competition in the field. In an effort to stay afloat, and to maximize earning potential, many of these practitioners have been led into subpar practices for issues beyond their scope of training and practice. Straying from their area of expertise and moving into the complicated topic of disease diagnosis and management can prove to be dangerous as well as extremely costly to the patients. I would advise extreme caution for anyone considering placing themselves under this type of care for complicated medical issues or disease management."
Mary Shomon: "Is there any scenario in which you can imagine it being reasonable to charge a thyroid patient, even if they come in regularly over a year and have a number of tests, rates like $10,000 to $15,000 for six months to a year? Is it, as some of the chiropractors are insisting, an entirely reasonable cost?"
Dr. Borenstein: "There is simply no justification whatsoever for charging such over-inflated rates for thyroid treatment and management. High level, 'boutique-style' physicians specializing in thyroid disorders rarely charge anywhere close to this amount for their customized services and certified medical expertise. It is thus in my opinion unreasonable and unjust for chiropractors, who have limited medical training or background in the complicated area of hormonal health, to charge these rates."
Mary Shomon: "You see many thyroid, adrenal, autoimmune and fibromyalgia patients in your practice. What issues are raised, in your opinion, if a thyroid patient chooses to go to one of these chiropractic 'thyroid centers?'"
Dr. Borenstein: "My main concern is that these patients may be misdiagnosed or, worse yet, there could exist a much more serious and complicated underlying issue that may be contributing to their symptoms. A chiropractor may easily miss those underlying issues due to their lack of expertise and their limited range of testing for diagnosis. In order to properly treat these disorders and manage them on a long-term basis, it is essential to get to the root of what's causing them, as opposed to just temporarily masking the symptoms that may be present. Furthermore, an improper diagnosis and/or course of treatment can often cause a domino effect of triggering further issues that can prove to be detrimental to the patient's long-term health."
Mary Shomon: "One of the chiropractors who is promoting the spread of these high-cost chiropractic thyroid centers told me that he has never been able to get any thyroid patients off their medication. Since chiropractors are unable to prescribe medication, this means that patients of these chiropractic centers need to continue to see, and get medication from, their regular physicians. What issues are raised by this situation, in your opinion?"
Dr. Borenstein: "The main issue of concern is that more often than not, the chiropractors are giving conflicting instructions and information to the patient, who is under the physician's care. The physician who is prescribing the medication, treating the issue at hand and managing the patient's health should be the only one guiding the patient's course of action in this complicated matter. There is the potential for things to get very complicated and messy when there is a third party involved. Moreover, the lack of ability for these chiropractic thyroid programs to eliminate the need for medication is indicative in itself that they are not adding any particular value or necessity to the patient's care of their thyroid issues."
Mary Shomon: "In defending their high-cost programs, the chiropractors keep saying that they are 'getting patients well.' But their evidence consists of a few testimonials up on their websites. How can patients know if any of these programs might actually work?"
Dr. Borenstein: "Unfortunately, they simply can't. Elaborate marketing can easily sway unknowing and desperate patients to buy into the many promises these chiropractors are serving up. The best advice I can give is for the patients to really do their research and look into the level of medical training for the services being offered, and to exercise extreme caution when making a decision."
Mary Shomon: "In a marketing pitch to other chiropractors, one of the chiropractors said that thyroid disease was 'red hot,' and that focusing marketing of these specialized programs to patients with chronic disease was like 'shooting fish in a barrel.' Do you think that the thyroid community should be concerned when we hear that this is an approach being promulgated by a network of chiropractors?"