The biggest difference is that in Navy healthcare you never have to worry about the cost of care the patient needs. What the patients need is what they receive -- quality care. It is very freeing to treat patients without the concern of dealing with a third party payer or patient finances. You don't have to be concerned about how sick the patient can afford to be.

A few years ago I interviewed Dr. Wayne Jonas, who served many years as a military medical physician and later was the director of the National Center for Complementary and Alternative Medicine at the National Institutes of Health . . .

I know Wayne. In fact, I was at his office yesterday.

. . . and he said the same thing. It strikes me, in thinking about this, that very few chiropractors in the United States (and probably anywhere) have had the opportunity to practice without that concern about patient finances and insurance reimbursement.

It is very liberating. It's wonderful for everybody.

I can certainly see how it would be. Do you foresee an expansion of opportunities for chiropractors in the coming years in large government and private sector health institutions?

I foresee the possibility of chiropractors joining the Public Health Service and other government institutions. Prior to my arrival at Bethesda, I worked in a joint government/private sector rural health venture. I envision chiropractic joining these groupings of private entrepreneurs with government incentive programs. Community health centers and rural health centers are examples of potential opportunities for chiropractors. I also envision the expansion of chiropractic into spine centers, pain clinics, major civilian hospitals, universities and other positions in institutional healthcare.

What is helping this along and what is impeding it?

Innovative chiropractors who pursue these integrative opportunities are helping this process, while chiropractors who operate in the fringe of evidence or ethical-based care impede these opportunities. It is my belief that detractors outside of our profession would have nothing ill to say about us, if we did not provide them with the material. I am a strong advocate of evidence-based and ethics-based care.

For those who aren't familiar with these terms, what is evidence-based care? Does it mean that you can't give any treatments without there being several large research studies proving their value?

No, no. As you know, evidence-based care involves taking the best evidence available. According to Dr. David Eddy, only 15 percent of what's done in medicine is truly evidence-based. Evidence-based care is not a destination, it's a journey. One of the things I tell people is, let's start with the safest option first. We know that surgery is not that safe and non-steroidal anti-inflammatory medications are not that safe, so let's try chiropractic first.

I read a comment by Dr. Joseph Keating where he said that all health professions use unproven methods, but it is never permitted to make untrue claims about those methods.

I agree with his comment.

Following up on what you said about ethics, what does ethics-based chiropractic care look like?

If somebody comes in, I would explain that I would like to try a particular approach, because I think it may be helpful. I may explain what research is or is not available to support my approach. I would not make unsubstantiated claims or predictions. The patient makes the decision as to whether to proceed. I can't say to them, "There's a 95 percent chance that I'll make you better." That's not true. Nobody has a 95 percent success rate. I read an informed consent form to all of my patients and I don't try to trivialize the complications that could occur. I am convinced that by doing this, it helps my patients to trust me. Ultimately, the decision to receive treatment is theirs.