Seizing on the opioid epidemic as a chance to expand their reach, naturopaths and chiropractors are aggressively lobbying Congress and state governments to elevate the role of alternative therapies in treating chronic pain. They’ve scored several victories in recent months, and hope the Trump administration will give them a further boost.

Their most powerful argument: We don’t prescribe addictive pain pills.

Unlock this article by subscribing to STAT Plus and enjoy your first 30 days free!


What is it?

STAT Plus is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond.

What's included?

  • Daily reporting and analysis
  • The most comprehensive industry coverage from a powerhouse team of reporters
  • Subscriber-only newsletters
  • Daily newsletters to brief you on the most important industry news of the day
  • Online intelligence briefings
  • Frequent opportunities to engage with veteran beat reporters and industry experts
  • Exclusive industry events
  • Premium access to subscriber-only networking events around the country
  • The best reporters in the industry
  • The most trusted and well-connected newsroom in the health care industry
  • And much more
  • Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.
  • In benchmarking comments to personal experiences and study, I can list my concerns and findings for your review:
    1. Unless successful diagnostics are formulated on initial treatment, prescriptions are safe & dosing accurate then there should only be one risk associated with patient outcome-adverse reaction(s) and follow up on prescribed.

    Jeff Clark’s “No treatment works for everyone. There is risk in everything.”

    All above could be true but it would be medicine in a vacuum! Why?
    Patients are mixing and misunderstandings emotional, physical and prescription related issues, ER’s are prescribing high dose painkillers before a true diagnostics is pre-established, medical private practices and clinics are swamped with confused, drugged and still in pain patients, seeking follow up on masked and added symptoms.
    “No treatment works for everyone. There is risk in everything.
    Diane Plotts – “The medical community looks at covering symptoms rather than treating the problem.” not always true.
    My assessment:
    WRONG PROCESS FLOW” is my experience.

    2. A BandAid or Successful Treatments?
    Good Chiropractors diagnose from a different perspective than Orthopedic or general practice medicine. Their diagnostics are at the structural static & and in motion body kinetics. They apply different corrective type treatments.
    In an ideal practice Diane Potts is correct –
    “Chiropractors seek to find and treat the problem.” I experienced successful treatment after a fall and 80% reduced arm motion. I achieved complete recovery, through chiropractic intervention after a few months of treatment, 12 years ago. Also, currently undergoing pain reducing interventions after a neck and head injury sustained 2 yrs ago. Treatment has been successful witn pain reoccurring, and incrementally reduced treatment frequency.
    There are instances where Chiropractics can only correct early un-addressed injuries, and alleviate pain rather than achieve complete closure to pain resulting from sustained neural injuries.

    This again is a call to incorporate Chiropractors Musculoskeletal treatment into the medical system to ensure population understanding of posture and behavioral issues with potential health consequences, where records are kept of early injury, merged with medical records and treatment addressed. Otherwise consequence accumulate, unknowingly inflicting added costs to Health Care.

    Incorporating Chiropractic treatments might reduce late chronic injury treatment and reduce late life surgeries improving the country’s overall health.

    3. Accupucture is a great ancient practice that enables better understanding of body function while reducing unknown stress induced pain but it’s practice varies and although highly regarded and academically studied, it is not widely accepted.

    4. Cronic Pain needs to be prevented to the point where opioids are not an option. There are multiple ways to learn how to prevent and tolerate pain, rather than use opioids.

    Opioids are the root cause of life loss, and current state of health care cost issues!

    Like mentioned before – “People with chronic pain need encouragement and help in exploring availability of achievable alternatives to opioids until they achieve success and relief”

    “When the problem goes away, the symptom goes away, and the need for opioids goes away.”

    • GVRange
      In my previous career I worked in high tech engineering for a manufacturing company. The number of uncontrolled variables in the at large human population are beyond our ability to enumerate. The idea that population level statistical data applies to all humans as if they come off a three sigma assembly line is laughable.

      Statistical data as well as historical and anecdotal experience arrive at the door of patient care with the same power: this might work. From there it is on the doctor to not harm the patient while they help seek a positive outcome.

      Number one reason a doctor prescribes a treatment? It has worked before when they used it with other patients.

      Corollary: no matter how much “science” trumpets the arrival, if in practice it hurts patients frequently, or doesn’t seem effective very often, it will not get very much use in clinical practice.

      All the bluster for population level statistical data is for economic barrier to entry on behalf of the patent drug manufacturers. Risk/reward is what regulators should be looking at, and when doing their job, demand and accept or refuse approval upon.

      Finally, to all of you wise and unwashed people out there: follow the literal human body count. Opiates, prescription drugs in general, and mistakes in hospitals are statistically relevant in the accumulated date — they kill people daily and in very large number. The evidence for this provocative statement is abundant.

      Show us the evidence for your exasperated hand wringing over “alternatives”, for how many are succumbing to chiropractic, acupuncture and naturopathic (that is non-drug) treatments. Spare us the anecdotes. We want to see large sample, statistically significant data for your fear mongering.

      Jeff Clark, ND
      Tualatin, OR

    • Jeff- You call upon hand wringers and skeptics to do the work of debunking your treatments, which has been done, while also asserting that your profession is not required to conduct research, because you treat anecdotally, one patient at a time. Ludicrous. We don’t describe theoretical unproven treatments and then wait to hand wrong when the RX fails. We roll up our sleeves and use science to help us move from theory to practice. I’m not sure what your resistance to this is about.

  • Having volunteered for over 20 years as a non-physician advocate, research analyst, and website moderator for chronic pain patients, I’ve seen a lot of insupportable claims made by naturopaths and chiropractors. Prudent skepticism is warranted with regard to such claims. A few basic rules of thumb might help all of us to keep a useful perspective:

    If a claim seems too good to be true, then it rather often is. There are no miracle cures.

    If a pill or remedy claims to correct a medical condition, then it is medicine, not a “supplement”. It will have side effects in some people, some of the time. It may kill a few and heal a few. A doctor can sometimes help you figure out which is more likely for you as an individual.

    As the Greeks told us (and Dr Allen Frances MD reminds us), there is a golden rule of thirds: for all physical (and arguably all “mental”) problems, about a third will resolve whether we do anything or not; another third will resolve with a physician’s assistance; and the final third won’t resolve or improve no matter what a doctor does.

    One study doesn’t prove a general rule in medicine or anything else. If it doesn’t replicate when done again independently, then it may have been fraud or simply in error in the first place.

    Beyond these thoughts, one correction: while some so-called “alternative” practitioners may be hyping the “opioid epidemic”, the fact is that when opioids are a contributing factor in an overdose death, they are almost always accompanied by alcohol and/or other drugs. It is an outright LIE to repeat the foolishness that half of all opioid-related overdoses are due to prescription opioids. Even when an opioid is of a type used in prescriptions, it is more often obtained on the street than from a doctor. Sometimes statistics lie and liars use statistics.

    • Thank you for that insight regarding the unfounded claim that overdoses are due to legal prescriptions being misused by the MD’s intended recipient. A lot of rubbish. They are mixed with street drugs being recreationally abused by drug addicts in a variety of cocktails.

    • Your comments on alcohol to opioids/drug interaction is of an even higher degree of risk and can occur even within consumption of alcohol mixed with some type vitamins/supplements for dietary and other physical muscle enhancement treatments. Scary!

  • Placebo medicine is very powerful and in most cases is dramatically cheaper than real medical intervention. Chiropractic and naturopathic practitioners help a lot of people despite there being little genuine scientific evidence that their hockus pockus does any good other than a psychological effect. The danger comes when people avoid scientifically valid treatment because they are so wedded to their witch doctor. But we’re in a new era of antiscience so in the end they will have to be responsible for their own ignorance.

    • DWW says, “Chiropractic and naturopathic practitioners help a lot of people despite there being little genuine scientific evidence that their hockus pockus does any good other than a psychological effect.”
      Okay, PROVE IT, loud mouth.
      Also, are you completely oblivious to the fact the so-called “scientifically valid treatment” you mention is also bullshit? Are you completely oblivious to the British Medical Journal clinical findings, What conclusions has Clinical Evidence drawn about what works, what doesn’t based on randomised controlled trial evidence? @
      Before you continue to lie with your fake news, get your facts right.

    • “Paging Mr Smith to the library..”
      Im sorry, did you say “prove it”? I must have missed it while I was looking up the analgesic benefits of topical cod liver oil. Which makes for amusing reading.

      I also just visited NASS’ on line version of spine magazine, typed two words into the search engine: “chiropractor” and “manipulation”, sorted them by relevance and read abstracts of the top ten hits. Not one of those articles, several of them large meta-analyses, endorse spinal manipulations as being a treatment of choice for low back injury, nor were there any studies defining dose or frequency of spinal manipulations. One study contradicted some of the statements made in this forum that on-site chiropractic clinics in medical ortho practices reduced overall Rx costs, and this study was more recent than the one Mr Smith(20 year old data) provided. Incidentally, in the top ten “hits” of this search were studies from neurologists describing clusters of injuries from inappropriate spinal manipulations.

      Thank you for letting us know about Spine Magazine and the good work of NASS.

  • It’s hard to fathom the arrogance of some of the MD’s interviewed for this article..I can only comment on the chiropractic portion of the article, but the evidence for spinal adjustment/manipulation for common musculoskeletal conditions is irrefutable. Many credible journals such as Spine, have published peer reviewed studies confirming this point…Amazing that 30 years after AMA vs wilkes victory for the chiropractic association, such archaic bias still exists against the profession

    • Brian, you must understand “chirophobia,” aka, medical bigotry, is bred into gullible med students and the public early on. Like racism, it’s inbred and compounded by their own lies. George McAndrews, attorney for the chiro plaintiffs at Wilk v. AMA, illustrated this prejudice when he put the AMA’s leaders in the witness box and asked them a simple question, “What do you think of chiropractic?” Of course, the all chanted the same drivel, “It’s unscientific, dangerous, quackery, etc.” The he asked them another simple question, “Okay, then prove it.” Of course, none of them could because they were parroting their own lies over and over again, just as they were taught by the Committee on Quackery. Sadly, this propaganda continues today as we witness with Jann Bellamy, “ach” and DWW, who remain anonymous because they are afraid to be exposed as liars and propagandists. Just think of white supremacists who continue to use the “n-word” and that’s identical to these medical trolls who use the “q-word” to malign DCs and any other CAM provider. I would love to debate these trolls in public, but they can’t stand the light of day.

  • A recent balanced article in JAMA (Journal of the American Medical Association) revealed that between 1997 and 2005, the costs for “standard medical management” of spinal pain syndromes (both neck and back) increased by an inflation-adjusted 63%, while measured outcomes for physical functioning, work or school limitations, and social limitations among adults actually declined. [1] During this same period, there was also an overall increase in the number of individuals who experienced neck or back pain (from 20.7% to 24.7%).

    During this same time period, the inclusion of a chiropractic benefit within a large managed care program (observed over a 4-year period) resulted in significant savings, as well as a reduction in the rates of surgery, and unnecessary use of advanced imaging, inpatient care, and plain-film radiographs. [2]

    These 2 studies, along with many similar findings, make it apparent that chiropractic should be the FIRST choice of management for those with musculoskeletal complaints. You may want to refer to the Cost-Effectiveness Page [3] or the Patient Satisfaction Page [4] for more supportive information on this topic.



    1. Expenditures and Health Status Among Adults With Back and Neck Problems
    JAMA 2008 (Feb 13); 299 (6): 656–664

    2. Effects of a Managed Chiropractic Benefit on the Use of Specific Diagnostic and Therapeutic Procedures in the Treatment of Low Back and Neck Pain
    J Manipulative Physiol Ther 2005 (Oct); 28 (8): 564–569

    3. The Cost-Effectiveness of Chiropractic

    4. Patient Satisfaction With Chiropractic

    • Here is an Op-Ed piece recently published in the Macon Telegraph. It’s information like this that makes the medical trolls run back into the darkness of anonymity like “ach” (BTW: why do you hide instead of revealing who you are?)
      New guidelines in spine care
      BY J.C. SMITH
      Special to The Telegraph

      Low back pain is epidemic in the nation with nearly 100 million sufferers that has led to the pandemic of prescription opioid painkiller abuse. Medical officials at the CDC and NIH as well as professional health associations have recently changed their guidelines to manage this pandemic of back pain and opioid addiction.
      On Feb. 14, the American College of Physicians updated its clinical guidelines on the management of back pain, “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians.”
      Overall, the ACP guidelines emphasize nondrug conservative “hands-on” treatments such as spinal manipulation and therapeutic massage as first-line treatments. The guidelines also state over-the-counter nonsteroidal anti-inflammatories or muscle relaxants should be considered only after nondrug therapy fails. The ACP guidelines strongly discourage the use of opioids for chronic pain as did the CDC guideline released last year.
      This new guideline comes on the heels of other significant medical studies on low back pain:
      In 2010 the North American Spine Society also recommended spinal manipulation— five to 10 sessions over two to four weeks — should be considered before surgery.
      In 2012 the NASS also found “patients with lumbar radiculopathy due to lumbar disc herniation, 60 percent will benefit from spinal manipulation to the same degree as if they undergo surgical intervention. For the 40 percent that are unsatisfied, surgery provides an excellent outcome.”
      The FDA found off-label use of epidural steroid injections to be no better than placebo, sometimes dangerous such as loss of vision, stroke, paralysis and death, and ESI have never been approved by the FDA for back pain.
      Recent research found Ibuprofen to be no better than placebo for back pain and can increase heart attack risk by 31 percent.
      New research also found Pregabalin (Lyrica) for acute and chronic sciatica was no better than placebo; in fact, the incidence of adverse events was significantly higher in the pregabalin group than in the placebo group.
      Researchers now suggest 50 percent of low back pain and 69 percent of neck pain is joint pain, which explains why spinal manipulation and other manual therapies that restore normal joint motion work so well for both pain control and functional improvement.
      This revelation is a big problem considering over 60 percent of prescription opioid use involves various musculoskeletal disorders, such as chronic low back (30 percent) and neck pain (5.2 percent), extremity pain (22.5 percent) and headaches (4.1 percent), conditions that chiropractors may help with nondrug treatments.
      Dr. Scott Boden, director of the Emory Spine Center noted: “Many, if not most, primary medical care providers have little training in how to manage musculoskeletal disorders.” He suggested “The best thing is to have an organized, integrated approach that uses state-of-the-art and cost-effective care.”
      People suffering from back pain should consider following the new guidelines and seek nondrug help from a local chiropractor before using any drugs, shots, or spine surgery.
      J.C. Smith, M.A., D.C. is a practicing chiropractor in Warner Robins.

  • The al information need evidence but need time for observation i m interestet many thanks.

  • Please get the terminology correct if you are going to write about this topic otherwise your credibility goes down: St John’s Wort is not a homeopathic remedy, it is a herbal remedy. Please also be respectful for all of the doctors you interview. Dr Telfair should be addressed as such, especially if you are referring to the other physicians’ with that title. Otherwise, the bias in your article is strong.

    • With all due respect: Dr Telfair may use the appellation “Doctor”, as many people with PHDs might, but in Massachusetts you may not refer to NDs as “physicians”, by statute. Your bias is strong as well.

  • The shrill demand for “evidence” in medicine has devolved into demagoguery aimed simply to maintain economic barriers to entry. It seems having a properly sized and cooked set of data is the main concern, never mind what that data actually communicates about reality.

    In my state of Oregon there are enough opiate prescriptions issued each year for every single resident, man, woman, child and new born infant to each have one of their own.

    In Oregon 83% of hospitalizations and 62% of deaths from opiate overdose result from opiate prescriptions. The leading gateway to heroin use and the rest of the overdoses is being cut off from legal opiate prescriptions once a patient has become addicted and labeled a substance abuser.

    What do the science-based zealots say in reply? Chiropractors, acupuncturists and naturopathic physicians are “not scientific enough”, and we should be more concerned about that — really?

    No treatment works for everyone. There is risk in everything. Risk/reward is where it is at. If we don’t first addict or kill the patient with dogma, there are always more low risk treatments to try.

    This is about the welfare of patients and the health of the nation — right?!

    Jeff Clark, ND
    Tualatin, OR

    • If I am correct, you do not have prescriptive authority nor training in the use of medications, including opiates. Im not sure that gives you the right to make any sorts of judgments about there efficacy, and certainly aren’t qualified to assert that your methods provide better relief to patients, because there is no body of evidence to show that.

    • ACH you are incorrect in your assumptions about my training and my prescriptive powers. I have a DEA license and can legally initiate and manage every medication mentioned in the recently issued American College of Physicians guidelines on non-invasive pain treatments, including the last resort opiates.

      The practice of medicine is inherently anecdotal. I treat patients one by one, using the lowest risk therapeutics first. My clinic has always been extremely stingy when it comes to prescribing opiate drugs. Every drug seeker who has tried to play us for pain meds has gone away frustrated. When I go to bed at night I have no doubt whether or not I have enabled someone to become a drug addict, let alone overdose and die.

      While you are trying to be clever there, I’m immune to your rhetoric. I have nothing to patent and sell at a high price, so I don’t need large sample statistical data to prove my case. I just need this one patient, the one in front of me to get better, and to not harm them in the process. I owe you no proof, nor anyone else. Only that patient needs to experience the proof that they are getting better and not being made worse.

      What all doctors owe all their patients is to monitor treatments and modify them in a timely fashion if they are not working or causing harm. Nothing in population level statistics tells you with 100% certainty how any individual is going to respond. The doctor owns this, or at least they should if any of this made sense. I’m not seeing how that ever happens in the 7 minute churned medical visit.

      Opiates are way beyond out of control. Many lives are being ruined. People are dying and children are being left without parents because of a problem that started with a doctor writing a prescription. That population level data does matter, and the facts are now in with more than sufficient statistical power.

      Its time to drop the dogmatic purity tests and remember that medicine originated as a healing tradition. Long before it became a mad money making profession serving the aims of big monied interests.

      Jeff Clark, ND
      Tualatin, OR

    • Well said, Dr. Clark. Don’t let the medical trolls get under your skin. Allopathic medicine has gone amok with ineffectiveness, abuse, and dangers. For example, the BMJ has published two clinical findings that found 2/3rds of medical care is unproven, ineffective or too dangerous to use. Another clinical finding in the BMJ found medical care in the US is the third-leading cause of death. Yet these medical trolls never discuss the sad reality of their own beloved medical care. Outside of the emergency departments, allopathic care is an expensive and ineffective fraud on the notion of real healthcare. Meanwhile, those health professionals like NDs, DCs, MTs, and nutritionists who work with real solutions to overcome the underlying causes of ill health and unhealthy habits get little attention in the media sponsored by Big Pharma and mediated by their MD shills on TV as we see with Sanjay Gupta. This medical monopoly has profited dearly but Americans are the sickest of all people in the advanced countries of the world according to the Commonwealth Fund. I suggest these medical trolls such as “ACH” and Jann Bellamy should not throw stones when their own medical house of cards is ready to crumble.

    • Jeff Clark, you said-” What do the science-based zealots say in reply? Chiropractors, acupuncturists and naturopathic physicians are “not scientific enough”, and we should be more concerned about that — really?”

      What needs to be emphasized here is that every other discipline in the business of healing and caring for the human body has standards of care and treatment algorithms based upon clinical evidence and research; and naturopaths as a group, feels it is being singled out for punishment for failing to do so. Not so! If you want to be entitled to reimbursement, if you want to be entitled to practice in hospitals and clinics, then your professional organizations are going to have to PROVE their safety and legitimacy. If I were you, Id be pushing for greater rigor and standards of care for your role, and spend less time demanding parity with MDs. This is challenging given your low number of NDs, but not impossible. Also have to say that because you lack standards of care and uniform licensing, your legitimacy is damaged by the rogue practitioners in your ranks who make ridiculous claims about some of their treatment results and damage your profession’s credibility as a whole. They should be weeded out, and that, too, is the job of a state board of ND. This is how professions evolve: Build the evidence, set practice standards, prove their value, gain legitimacy, cull out bad seeds.

  • The issue we’re facing is that, with very few exceptions,the medical community looks at covering symptoms rather than treating the problem. If your arm is broken, taking a pill to cover the pain isn’t solving the problem. Neither is waiting for the problem to become worse and then radically intervening with surgery. When the problem (not the symptom) is treated early, the body is often able to heal. Chronic pain is a symptom of the problem that is not being addressed. Back injuries are rarely treated in a medical setting. Pain is covered up with pills and the patient is led to believe that they’re fine because they can’t feel the pain, or that nothing can be done to help them. Chiropractors seek to find and treat the problem. When the problem goes away, the symptom goes away, and the need for opioids goes away.

    • You said: “The issue we’re facing is that, with very few exceptions,the medical community looks at covering symptoms rather than treating the problem.” Im not sure you realize ho demented that statement is. Of course Medical doctors look for treating problems. Your analogy with the broken arm was ridiculous! The implication is that a doctor looks at someone’s broken arm, and without setting it or fixing it, just gives someone an opioid. Really?

      And there in lies the problem with your rank and file: A propensity to exaggerate the inadequacies of MDs, while also glorifying your own noble contributions. Whilst also sounding demented.

  • Patients with health care issues are NOT CRIMINALS. Yet the authorities that are selling meth, opiates, cocaine and many others, want the drugs to stay illegal so that they can keep making a million dollars a day.
    When all drugs are legal and over the counter, that is the day that the problems with drugs will start going away.
    The ISSUE is BLACK MARKET manufacturing, sales and distribution.
    So, those authoritarians are the ones involved with the black market,
    these are the ones standing up and saying KEEP DRUGS ILLEGAL,
    Yeah so you can make a million a day.

    Again, the problem is black market, and once that is gone, the problem
    will also be gone. Those people that drink the kool-aide, will support
    these black market mayors, police, congressmen and senators and higher up.

Comments are closed.

A roundup of STAT’s top stories of the day in science and medicine

Privacy Policy