In Defense of Alternative Health Care
In Harry Nafpliotis's inflammatory and self-serving letter to the editor (ICQ, 2003/4; the letter referred to the cover story "The Healers: Alternative Health Care Practitioners" in ICQ 2003/2), he pompously paints chiropractic and alternative medicine as unscientific and inferior to physical therapy. Ironically, one need look no further than the biomedical literature to refute Mr. Nafpliotis's bias and personal opinions so angrily expressed in his ad hominem attack.
Contrary to Mr. Nafpliotis's expressed opinions, the ICQ couldn't have been timelier in focusing upon complementary and alternative medicine (CAM) as the focus for an issue highlighting the success of its graduates. Studies suggest that between 30 percent and 50 percent of the adult population in industrialized nations use some form of CAM to prevent or treat a variety of health-related problems. In the United States today, it is estimated that CAM is responsible for 629 million visits per year to practitioners of CAM, thereby exceeding total visits to all U.S. primary care physicians. The Journal of the American Medical Association reports that expenditures for CAM professional services is conservatively estimated at $21.2 billion, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all U.S. hospitalizations. Clearly, efficacy and patient satisfaction are driving these trends of public demand, utilization, and spending.
Of all the so-called CAM professions, chiropractic has made the largest inroads into private and public health care financing systems and is increasingly viewed as an effective specialty by many in the medical profession. Thankfully, other physical therapists and physicians do not share Mr. Nafpliotis's desire to distance themselves from chiropractic. In fact, large numbers of physicians are either referring to or practicing themselves some of the more prominent and well-known forms of CAM, and many physicians believe that these therapies are efficacious. Another recent study of physician attitudes toward CAM determined that more than half of providers had referred a patient for biofeedback or chiropractic care.
Much of the positive evolution of chiropractic can be ascribed to a quarter century-long research effort focused on the core chiropractic procedure of spinal manipulation (SM). This effort has helped bring SM out of the investigational category to become one of the most studied forms of conservative treatment for spinal pain. Mr. Nafpliotis is obviously ignorant to the fact that to date at least 73 randomized clinical trials of SM have been conducted. Most trials have been published in general medical and orthopedic journals. Of 43 randomized clinical trials of SM for various low-back pain conditions, 30 favored SM over comparison treatments while 13 found no significant differences. No trial has found SM, to its credit, to be statistically less effective than the comparison treatment. Of 11 randomized clinical trials of SM for neck pain, 4 had positive findings and 7 were unequivocal. Seven of 9 randomized clinical trials of SM for various forms of headache have also found positive.
The effectiveness of chiropractic methods is further realized in studies of patient utilization and satisfaction. In a recent study of patients with musculoskeletal pain, 37 percent of those surveyed chose to treat with a conventional provider while 54 percent instead turned to CAM to treat their condition. This study, published in Annals of Internal Medicine, reported that chiropractic, massage, and relaxation techniques were the most commonly used CAM treatments for back or neck pain and were rated as "very helpful" for back or neck pain among users (61 percent, 65 percent, and 43 percent, respectively), whereas conventional providers were rated as "very helpful" by only 27 percent of users.
So, while it may be easy to dismiss Nafpliotis's statements as professional bigotry from a physical therapist holding on to values indoctrinated in him 40 years ago, the evidence convincingly shows that chiropractic and CAM are both effective and highly utilized.
As for chiropractic and physical therapy harmony, I would point out that I and many other chiropractors employ physical therapists.
Last, other allied health programs and specialties taught at IC do not overshadow the prowess of IC's physical therapy program. Conversely, the professional opportunities enjoyed by IC graduates in the CAM field reflect the diversity of the College. Physical therapy is not the only department in IC's School of Health Sciences and Human Performance. My bachelor of science degree, from the Department of Exercise and Sport Sciences in the same school, provided me with the prerequisite coursework necessary to continue my education and receive a professional doctor of chiropractic degree.
So, how curious it is for our critic, Nafpliotis, to request the ICQ to profile a PT who excelled as a professional, as a research scientist, as a professor, and as an inventor. Why, these attributes are exactly those of the Ithaca graduate who appeared on the cover. He just had a B.S. degree in ESS from IC instead of a B.S. in PT, and a D.C. degree as well.
Christopher J. Colloca '90, D.C.
Editor's Note: Dr. Chris Colloca was among the "Healers" featured in the cover package of the ICQ 2003/2 issue; his photo appears on the cover.
More On Alternative Health Care
I am responding to the letter you published from the physical therapist, Harry Nafpliotis '64, in the last ICQ concerning alternative health care providers. Mr. Nafpliotis's bitter letter is obviously fueled by envy and ignorance.
Why would one be "offended" because an article acknowledged the benefits of health care available to the public outside of mainstream medicine? As a chiropractor, I cannot speak for the other practitioners represented in your article. Further, not knowing enough about the methods or beliefs they employ in practice, I think it wise to remain quiet and without opinion regarding matters of which I am uninformed. Why should an ICQ cover feature with a "chiropractor of all people" be considered a blow to the physical therapy program at Ithaca? Instead of writing a letter that spews unprovoked venom at other health care providers (people who appear to be well rounded, professional, ethical, successful IC graduates), why not make a concerted effort to extol the virtues of one's own profession? Especially if one feels that physical therapists were slighted by not receiving mention in the article.
If Mr. Nafpliotis was as educated as he claims as to have been in "traditional Western ways" based on laws of "empirical studies and research," he would not exclude chiropractic from the mix. Our profession began in 1895 in Iowa, and since then there have been countless studies published in scientific peer-reviewed journals (e.g., Journal of Manipulative Physiological Therapeutics, Spine Journal) that affirm not only the benefits of chiropractic but also the fact that a large percentage of the population seeks and uses these services. Mr. Nafpliotis would have us believe that these people subscribe to the "psychobabble of alternative healing" rather than the efficacious results my colleagues and I have been providing for years.
Studies have shown that the public spends more dollars out-of-pocket on alternative health care than on mainstream services. Given that chiropractors are the leading providers in alternative care, it makes one wonder which forms of care are really alternative and which are mainstream? Do our services exist only to "meet the demands of the incompetent," or do we continue to thrive because we offer valuable care that certain other health care professionals cannot always provide?
I believe that people should be able to choose for themselves where their needs are best met and their dollars best spent. Based on the numbers, many people choose alternative care not because they have been brainwashed with "illusions and delusions." Rather, they are educated and often opt for forms of treatment that are not dependent on prescription drugs and/or surgery as a first line of defense.
I received my doctorate in chiropractic in 1995. Chris Colloca (featured on the cover of ICQ) was not only a classmate of mine at Ithaca, but a classmate in chiropractic school as well. If Mr. Nafpliotis had done any research at all he would have learned that Dr. Colloca has quickly become a most respected, knowledgeable figure in the health care industry, not just chiropractic. He has authored many studies and papers that have been published in various journals popular within the medical community, and he has been invited to lecture all over the world to specialists in all fields of medicine and health care.
It is an insult of the highest degree to state that my peers and I practice "not for nobility but for financial reward." I have been in private practice with Dr. Steven Levy '91 in Virginia since 1996. We are licensed by the Virginia Board of Medicine and have successfully treated thousands of people; we are proud to offer them the finest care and service possible. I chose my career path because I wanted to work with people. Further, I wished to own my own business and be my own boss. And, like many in any profession, I desired financial independence. Hard work and ethical business practices should allow anyone to achieve these goals. Should I feel guilty because I have done well financially? How many people, including Mr. Nafpliotis, don't desire the same?
Just as in a wheel each spoke is integral and plays an important part, in health care there is no one profession that is better than another. All have their place. In my practice I have established extensive relationships with numerous medical doctors, orthopedists, neurologists, and -- yes -- physical therapists. We regularly refer back and forth to one another based upon each patient's needs. I am threatened by none of them and always welcome their knowledge, respect their opinions, and appreciate their trust in me.
The only time I seem to encounter the same narrow-minded views as those of Mr. Nafpliotis is when I am dealing with someone who might possess an "old school" way of thinking, blind to the advancements and breakthroughs of health care professions outside of the "medical world."
Chiropractors, like medical doctors, are considered to be primary health care providers, meaning one does not need a referral to seek our care. Physical therapists are considered secondary providers. Referrals are normally required from a primary provider before care can be sought or rendered by a physical therapist. Strict guidelines often prevent PTs from being able to treat without a referral from someone like myself. As a result, PTs rely heavily upon primary providers for business.
Because I enjoy the freedom of a primary provider, I may treat any and all who come to my practice, regardless of whether or not they have a referral. Many PTs have long desired to become primary providers, as they would no longer be dependent on me and my peers before they would legally be allowed to treat patients. I understand and appreciate this.
Mr. Nafpliotis would better serve his needs and the needs of all physical therapists if he came down from his soapbox and proclaimed the values of his own profession, rather than balk at the benefits provided by others.
Michael S. DeRose '91, D.C.
A PT Chimes In
I read Harry Nafpliotis's letter regarding the "alternative caregivers" cover with interest and dismay. I respect Mr. Nafpliotis's level of education, his desire to protect physical therapy as a profession, and his pride in his alma mater. However, his letter reflects an inflexibility and fear pervasive in our profession and in society today, an attitude which is likely a contributor to the difficulty physical therapy as a profession has experienced.
I am a 1989 graduate of the physical therapy program at IC. I have a unique look at the issue, having been on both sides of the fence. I practiced as a physical therapist for nine years until being sidelined with CFS and fibromyalgia (FMS). Prior to my illness I was a hard-core scientist, a "Western practitioner." CFS/FMS changed all that.
In battling my illness I tried the scientific approach for quite a while, with absolutely no improvement -- in fact, my condition worsened in many instances with Western intervention. When I finally got desperate and tried an alternative treatment, I began to see a definite improvement. And that's when my belief system began to change. Since then I have benefited tremendously from craniosacral therapy, myofascial release, Feldenkrais, acupuncture, Chinese herbs, tai chi, therapeutic massage, meditation, ayurvedic medicine, and, most effective, yoga. If it weren't for what Mr. Nafpliotis calls the "joke" of "alternative health methods," I might still be in bed. On the contrary, I'm living a full and rich life, and I owe it to complementary methods, as well as to the willingness of complementary and Western practitioners to work together to achieve a common goal.
I treated several patients with FMS before I got sick myself. I used Western technique, and the patients never seemed to respond. Now, from the other side of the fence, I know why. I don't expect PTs who have never experienced chronic illness and dysregulation of body systems to understand why the Western approach often doesn't work, but I would hope for an open mind. How many patients, I wonder, might Mr. Nafpliotis have dismissed in his close-mindedness as malingerers, or emotional treatment saboteurs, or simply impossible to help? I've been through a fair share of such practitioners myself.
Studies and evidence are quite helpful, but they are not the do-all and end-all. It is the close-minded stance of many PTs that is hurting our profession today. Certainly there is a place for Western medicine, just as there is a place for complementary medicine. And, most importantly, they both must be willing to work together, with respect for each other.
Such a strong reaction as Mr. Nafpliotis had to the article suggests to me fear, as well as a disconnect from the intuitive side of self. If Mr. Nafpliotis really feels that Western medicine is the only way, then that is how he should practice. His effectiveness will determine his level of success. If alternative techniques are so much "psychobabble," then their ineffectiveness will be their demise. Funny, though, the more time passes, the more popular they become. That mere fact speaks for itself.
I commend Ithaca College for including the article -- it is in keeping with its progressive and open-minded nature, indicative of what makes it an excellent college. Next time, do interview PTs, though. I'm sure you'd get an earful on alternative healing!
Gerianne Carillo '89, PT
Milford, New York
Another D.C. Speaks Up
I was pleasantly surprised at your recent cover story, "The Healers: Alternative Health Care Practitioners." As a 1973 biology graduate of IC, I was a recipient of the truly outstanding premedical education that is available to IC students. I continued in my professional education at the National College of Chiropractic and received a doctor of chiropractic degree in 1977. From the thousands of patients I have treated and the thousands of doctors whom I have taught over the past quarter century, I want to express my appreciation to IC for the great liberal arts education I received.
It is unfortunate that a graduate of the physical therapy program would feel so slighted or offended by the success of other IC graduates who went on to successful careers in the healing arts. Ithaca College's outstanding physical therapy program is widely known and certainly deserves to be. I have read numerous articles about it in past issues of the Ithaca College Quarterly. What may not be so widely known is the number of IC graduates who received a strong foundation as undergraduates and then went on to excel in a variety of professional careers. Your article did a good job of introducing the field of "alternative health care."
Robert M. Blaich '73, D.C.
I have to respond to a very disturbing letter written by the so-called "professional" health care provider who wrote to disparage the IC Quarterly article on alternative health care providers.
I took offense because of the inflexibility of the writer to recognize anything that could help his work in physical therapy, and to his outright rejection of things that can and do work -- and which have been in common practice (not necessarily in this country) for many years.
To be honest, I do not personally condone alternative practices such as using crystals or powders in massage, nor do I think all people will benefit from chiropractic. I didn't, and my chiropractor told me at the point when she couldn't do anything for me; she was right, and I respected her for her honesty. You'll find overstated "cures" in every (medical) profession, and some physical problems need to be addressed in multiple ways. Knowing that blending physical therapy with alternative health care (e.g., massage) can have a beneficial effect on patients might just make this "Ph.D." smarter.
The writer's implication -- and I'll pick on massage therapy -- is that it is total bunk and has no place in anyone's health regime. Nonsense! Why is it that physical therapists, doctors, nurses, chiropractors, and other health care providers have been referring their clients to my wife, a massage therapist, for 19 years? Well respected and appreciated by medical professionals and her clients, she has dedicated her physical well-being (an understatement) to her work, doing real deep-tissue massage and being mentally involved in every session. I have a feeling Mr. Nafpliotis doesn't "listen" to his clients the way she does, to help physically and mentally release their problems. The ones that don't appreciate my wife are those who have a mental block or phobia or are just too lazy to learn.
Mr. Nafpliotis's Ph.D. degree doesn't mean he can't be wrong. He's clearly proved it in my mind.
T. H. Butler Smythe II '77, Lt. Cmdr., USN, Ret.
Tall Timbers, Maryland
Dismay at Previous Letters
I was discouraged -- and embarrassed, frankly -- by some of the letters from my fellow alumni in the fourth Ithaca College Quarterly of 2003.
One letter -- from a physical therapy alumnus offended that chiropractic was featured in a previous Quarterly -- categorically denounced all alternative healing practices. And yet 27 of our nation's medical schools offer courses in alternative medicine, including Harvard, Columbia, Stanford, and the University of Maryland.
Another letter accused the College of putting forth a liberal (read "leftist") agenda. This writer claims that while his time at Ithaca College "opened [him] to new ideas," he would not be making any further gifts. Is his notion to reward the College that provided him with a good education by withholding his financial support? I don't follow the logic. And at a time when the need for such support cannot be overstated, such a decision seems shortsighted.
I am an alumna living in Ithaca, and I am on the campus regularly. I served for a number of years on the Alumni Association board, I attend many cultural events each year that are open to the College community, and I occasionally visit classrooms as a guest lecturer. My experience is that all points of view are encouraged and represented on this campus among faculty, staff, and students. President Peggy Williams is scrupulous about encouraging the expression of all perspectives. She sees the College as a place where an extended and sophisticated exploration of ideas -- both conventional and controversial -- can happen and should happen.
Ithaca College is not a haven for dogma. It is, however, a place that welcomes open, reasonable, and respectful debate and dialogue from many perspectives in the elusive pursuit of truth. That quest will certainly elude us if we open our minds only to certain ideas.
One final note about people who teach. Professors are, by their very nature, curious and interested in the exploration of ideas. To do their jobs well, they must be open-minded. Does that mean they are all politically liberal? My own experience as a student from 1968 to 1972 brought me into contact with professors whose views covered the political spectrum. But every one of them was eager to talk about, debate, and explore points of view that did not necessarily agree with their own. And that's what a "liberal" education is all about.
Julia C. Bonney '72
Ithaca, New York
Terrorism: Further Refining Our Definitions
I thoroughly enjoyed Michael McKenna's essay dealing with terrorism (ICQ, 2003/4). I was a little surprised that he didn't consider two significant ingredients of terrorist activity. One is the power factor. Terror activity is usually carried out by those not in a position to confront opponents openly on equal footing. Another factor is anonymity, which is essential for sustained activity and avoidance of consequences of such behavior. In avoiding consequences, terrorists recruit martyrs. They convince martyrs that the cause is more significant than life, then pat them on the head to prevent them from asking why the terrorist recruiter isn't doing the martyring himself.
Stanley "Essdale" Wilson '66
Binghamton, New York
Just a note of appreciation for the "gorges" photograph of "Beautiful Ithaca" (back cover, ICQ 2003/4). The photograph evoked rich memories for me (as I imagine it did for other music majors whose classes and concerts took place downtown prior to the South Hill campus construction): glorious autumn colors in the gorge, the gorge temporarily imprisoned in winter ice, fish leaping upstream in the glow of springtime.
While an aesthetically pleasing college campus might be situated anywhere, we alumni of Ithaca College are blessed to have gained our college education in this sublimely beautiful natural setting.
I framed the photo!
Ruth Sragow Newhouse '64
Editor's Note: The photograph was taken by Ithaca photographer George Sapio of Bad Dog! Studios.
Remembering C. Hadley Smith
One of the nicest people and most talented photographers I know died January 5. C. Hadley Smith spent several decades documenting the development and growth of Ithaca College. I recall days when it seemed Hadley was more than one person because he was everywhere on campus -- from athletic fields to stage performances, science labs, or the academic quad. Even with such a busy schedule, he had the ability to capture people and places with a flair.
Whether it was in the College's scattered downtown facilities or on the South Hill campus (or even from overhead in an airplane), Hadley's photos reflected the flavor of College life in a way that made people remember not just the photographs, but also the photographer who took them. Some attribute that charm to the twinkle in Hadley's eyes, or his knack for making his subjects feel at ease. Whatever it was, he excelled; Hadley's photos are testimony to his skills.
I met Hadley Smith when I was a student, and continued to know and appreciate him and his work for 40 years. Hadley and his late wife, Gertrude, were more than personal friends; they were professionals with talents that most people never knew. Hadley even hosted a photography show on WHCU radio in Ithaca. Imagine that, photography on the radio!
In the 30-plus years that Hadley chronicled the College, as well as the city of Ithaca and its environs, he took (by his own estimate) millions of photos. Fortunately, the many thousands of campus photographs produced by Hadley, and his negatives, are part of the archives at Ithaca College; thus, his images will live on for many more decades to come.
Photographs by C. Hadley Smith were center stage in 1992 during the College's centennial celebration and in the late '90s at the college's Handwerker Gallery. Shortly after his death, a sampling of his work was displayed in Job Hall -- another tribute to someone who made an entire campus community feel at ease.
David I. Stewart '67