The move toward chiropractic is consumer-driven. "A lot of patients are really ticked off with medicine right now," says Woodson Merrell, executive director of the Continuum Center for Health and Healing, a lower Fifth Avenue outpost of Beth Israel Medical Center whose waiting area is a cross between the reading room of a well-endowed library and the foyer of a sleek Japanese restaurant. "They want nothing to do with conventional therapy." Thus, the Continuum Center offers chiropractic, acupuncture, and aromatherapy along with the standard playlist: pediatrics, gynecology, internal medicine. In this, it has created a smart business model.
"We tend to see our patients more frequently," says Karen Erickson, the center's senior chiropractor and one of the first to be credentialed by a teaching hospital. "We also tend to spend more time with them, generally, than do doctors, so we really know them. It's common that I'm the portal of entry for a patient into the health-care system -- I'm in a position to refer that patient to an internist, a gynecologist.
"It's good for the patient and for the doctor who gets the referral," adds Erickson, whose office, fitted out with an area rug and an elegant green leather chiropractic table, smells pleasantly of peppermint. Her soothing room and equally soothing, assured manner help explain why she, along with the resident acupuncturist, has the center's most prominent practice, one that includes designers, performers, and writers, among them playwright Warren Leight.
"Five years ago, I was rear-ended by a truck," he says. "When you have something like that, it reverberates through your body in ways you don't expect. You might feel better five months later and worse two years later. You end up chewing a lot of Advil and Vioxx.
"I was sent to Karen by a friend who had migraines. I was skeptical, but I'm a writer. I'm skeptical of everything," says Leight, whose Side Man won the Tony in 1999. "I thought I'd give it a try because the painkillers were a drag. It had not occurred to me that you could go to someone who would run her hand down your spine and know where it's hurting. She always knows where it hurts. I go to Karen like an 80-year-old and come out like a 45-year-old. I also haven't gotten as sick as often since seeing Karen," Leight adds, saying of a session with her, "It seems to re-center your body's immune system."
That's the kind of statement sure to get an orthopedist's back up. "Any suggestion that chiropractors have the ability to treat non-muscular skeletal conditions like digestive and visual problems and breathing difficulties, I think it would be appropriate to apply the word bunk," says Eli Bryk, chairman of orthopedic surgery at St. Vincent's Hospital. "Many people swear by chiropractors, and they're not crazy," he concedes. "There have been findings that patients with simple muscle aches do receive benefit from manipulation. But really, what a lot of chiropractors are doing is physical therapy."
Seckendorf bristles at the chiropractor–physical therapist comparison. "We both use some of the same modalities, like hot and cold packs, and we both do hands-on therapy," he allows. "But physical therapists are not spine specialists. We are."
This whole identity and image thing is something chiropractic has been struggling with for years. Not too many years ago, chiropractors were, at best, regarded as part of the alternative-medicine movement, at worst as quacks and bone crackers. "We've gotten away from the word crack," says chiropractor Lawrence DeMann Sr., whose patients include politicians and theater directors. "Now we call them adjustments." Until the matter was successfully challenged in court in 1987, an amendment to the American Medical Association's canon forbade doctors from referring a patient to a chiropractor or accepting a referral from a chiropractor. "The AMA referred to chiropractors as rabid-dog killers and latent homosexuals who liked to put their hands on people," says Jerome F. McAndrews, spokesman for the Arlington, Virginia–based American Chiropractic Association.
When Demann began practicing 35 years ago and was at a party with some M.D. friends, he was asked about his specialty. "I said I was a chiropractor, and a pall fell over the room," he recalls. "Now when I go to a party and say I'm a chiropractor, people will crowd around and say, 'I've got a pain in my shoulder.' 'There's a pain in my back . . . What do I do?' " Last year, according to McAndrews, 25 million people headed to chiropractors to find out, a 47 percent increase from the early nineties.
Still, the adjustment in thinking has only gone so far. Doctor taxonomy has it that if you can't get into med school, you go to med school in Mexico. Failing that, you go to osteopathy school. If you can't get in there, you go to dental school (except in New York, where the status order is reversed). If you can't cut it there, you head for podiatry school. If you couldn't get in anywhere, you became a chiropractor.
Seckendorf himself was premed at Boston University. "I wanted to go into health care," he says, "but I knew I wanted to do something that would let me do both diagnosis and hands-on treatment and be involved in prevention." Bingo.
In his eleven years of practice, he has tried to make a distinction between his M.O. and that of his colleagues. "The classic chiropractic approach might be to look at someone and say, 'You have one leg that's longer than the other, your left shoulder is higher than the right,' " Seckendorf says. "Your muscles should be lengthened. We should adjust your spine to take pressure off nerves and make your body work more efficiently. The philosophy is that you develop inherent mal-positions in your spine as you move through life."
He takes only those patients who come to him with a specific spinal complaint, turning away people who are interested in chiropractic as prophylaxis or as a sort of glorified massage. He deals strictly with neck and back problems, mostly herniated discs, keeps his volume low and his patients' tours of duty short. The average treatment runs for two months with visits two to three times a week, and is, says Seckendorf, consistent with orthopedic treatment.
"If you were lying on my table, my therapies would be traction, electrical stimulation, heat packs, ice packs, and manual lengthening of the soft tissues. We don't do manipulations or cracking here. It's not that I'm against it for certain conditions, but for my patient population, which is mostly disc herniations, it's contra-indicated."
"What sets Doug apart is that he evaluates patients as much as a medical doctor does, and he's careful to rule out other, more serious causes, like malignancies, kidney or ovary disease, and aneurysms," says orthopedic spine surgeon Baron Lonner. "He also doesn't keep them coming back for unnecessary treatments and gives them a long-term plan of back maintenance.
"Before," he adds, "my feelings about chiropractors were neutral to negative. But because of Doug, I have a more open attitude about them."
Pain, as Cilda Shaur, the former dancer, learned, tends to make you more open-minded. "I was 23 when I was first injured and I thought I would never dance again because I was so messed up. The idea of someone cracking my back -- that was not the thing to do. But I wanted my life back. And then I went and I was fine within a month. Now I'm moving to Boston and all I can think is, Oh, God, I've got to find another chiropractor."