In the 2012 draft of the Council on Chiropractic Education’s Accreditation Standards one of the bullet points in their mission statement reads, “Serving as a unifying body for the chiropractic profession.”
In a September 1st, 2010 document to interested parties on the Life West Chiropractic College website titled “A discussion of a limited number of changes in the CCE’s 2007 version of the Standards for Doctor of Chiropractic programs and proposed revisions to the same”, college president Dr. Gerald Clum seems to disagree with that statement. He summarizes his concerns thusly,
Concern: The items outlined above indicate an attempt to move the profession:
- Toward the Doctor of Chiropractic Medicine perspective
- Away from any use of the term subluxation
- Toward the inclusion of drug therapy
- Away from being a drugless discipline
- Toward a generalized common definition of primary care as used in primary care medicine
- Away from any definition of chiropractic and what a chiropractor does
And so, the thorny issue of unity never goes away. Do we move forward into a world that knows only “chiropractic medicine” or do we maintain that chiropractic is and always should be “separate and distinct”? Or, can we have it both ways? One thing is sure. If we continue to confound the public as to our identity we will never see the numbers of patients to which we believe we are entitled.
Relevant documents…
- The 2012 draft of the Council on Chiropractic Education’s Accreditation Standards
- CCE Standards for Doctor of Chiropractic Programs and Requirements for Institutional Status January 2007
- Dr Clum’s comparison of current and draft standards
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- BTW, you can make comments on the draft using a form on the
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“Thorny issue” indeed. What unity are we speaking of ? Unity within the chiropractic profession or unity under the medicine/health insurance model. This is the dilemma I’ve experienced since I became a chiropractor. We are being squeezed by health care insurance industry,big Pharma and medicine. We also attack our fellows chiropractors. At the same time there appears to a large imbalance of the supply of chiropractors and patients receiving/paying for there services. Something has to give and compromises will be made. The Affordable Health Care Act (if it prevails) claims to be very interested/directed at “preventive services”. This could be an area that chiropractors could serve. We may need to have it both ways. Otherwise, we will continue to be pushed around and have our scope challenged. There’s no easy answer in my opinion. Many will say we need to continue the fight. They may be correct. I just know there’s been plenty of collateral damage to chiropractors and chiropractic. I think we need to ask ourselves, should we compromise/evolve with evidence-based patient care and/or should we could we be left behind.
I think it’s safe to say we’ve peaked as a profession under our current model and maybe that’s okay. I do think we will need to be more integrated with medicine if we are to go ‘to the masses.’
Having said that I think medicine maybe a dying profession, at least as it is presently constituted. Kind of like the housing market, it over priced itself into a collapse. Maybe medicine is doing the same thing.
Is it such a bad thing to have our scope expanded? I’m starting to think it would be a good idea to be able to manage taking the patients off their medication and replacing the toxic meds with the right foods and supplements, or just allow the good ol’adjustment to work as it should.
The writing is on the wall! The profession is about to hit the rocks and it has a choice; either it can cave in to the dictate of evidence based medicine and the randomised control trial or dig in and define what it is that chiropractors do.
For once, the UK is ahead of you guys on this one. A group of bloggers have brought mass complaints against individuals for making unsubstantiated claims about treatments, the GCC (general chiropractic council) then sifted the ‘evidence’ and published the list of the ASA (advertising standards authority)approved, or ‘evidence based’ treatments.
Now this is the crux of the issue: you can’t treat for, nor claim to treat for anything other than those listed conditions without the evidence to back it up. The evidence gold standard is an RCT, the rest are graded levels of evidence. SMT in isolation is not a model which suits the RCT, nor does a clinical environment suit. Clinical experience and anatomical ‘critical thinking’ does not suit either. So while the rationale is that we become evidenced based, the nature of evidence is a positive or negative outcome, completely at odds with the way that every chiropractor approaches any given condition.
Example: Sciatica, if we follow the letter of empirical evidence, there is no RCT that says we can treat. So next time a patient walks into your clinic in tears, you will have to tell them to go to their doctor, get the strongest painkillers they can and wait it out, because you don’t have the evidence yet to treat them!! You could say that ‘we can do a therapeutic trial’ but you’d be making a claim right there without knowing the outcome.
Preventative healthcare, wellness? No evidence!!! You and I both know from clinical experience it works but once you nail chiropractic to the RCT, you’re a manual therapist who can only treat a limited range of conditions on a pain based outcome. Once a patient is better, the outcome is positive – bye bye patient.
Read Richard Lanigan’s Chiropracticlive.com, and read the bloggers:
sketic barista
skepticat
zeno’s blog
Start reading and try not to take it too hard, but if you let the profession align itself with the condition based model of medicine then the principles of chiropractic will be dead in the water.
Good luck.
There is a survey concerning this issue posted at the following link,
Please take a few minutes and answer the questions posted:
http://www.surveymonkey.com/s/FTN3VQH
“Thorny issue” indeed. What unity are we speaking of ? Unity within the chiropractic profession or unity under the medicine/health insurance model. This is the dilemma I’ve experienced since I became a chiropractor. We are being squeezed by health care insurance industry,big Pharma and medicine. We also attack our fellows chiropractors. At the same time there appears to a large imbalance of the supply of chiropractors and patients receiving/paying for there services. Something has to give and compromises will be made. The Affordable Health Care Act (if it prevails) claims to be very interested/directed at “preventive services”. This could be an area that chiropractors could serve. We may need to have it both ways. Otherwise, we will continue to be pushed around and have our scope challenged. There’s no easy answer in my opinion. Many will say we need to continue the fight. They may be correct. I just know there’s been plenty of collateral damage to chiropractors and chiropractic. I think we need to ask ourselves, should we compromise/evolve with evidence-based patient care and/or should we could we be left behind.
The above seems to be a goal for the straight chiropractic profession. It is undoubtedly a very noble goal, for we know that an individual without vertebral subluxations functions better on every level. Further, there is nothing wrong with having lofty goals as long as they are reasonable. I am not quite sure that a subluxation-free world is a reasonable goal, especially from a philosophical viewpoint. Perhaps it would be more appropriate to say our goal is a “regularly-checked and adjusted-when-necessary world.” After all, if we see the vertebral subluxation as a worldwide plight that occurs in all people of all ages as a result of the normal activities of life, we cannot expect to wipe it out as we would some medical plague.
I agree with Dr. Binns. There is too much at stake for us and our patients if we align ourselves with the condition based model of medicine. We need to unite our ranks and fight to keep ourselves separate and distinct.
Whats going on there. Ive been reading your posts. They are great! thanks!
“Faith is the great cop-out, the great excuse to evade the need to think and evaluate evidence. Faith is belief in spite of, even perhaps because of, the lack of evidence.” Richard Dawkins
“We may define ‘faith’ as the firm belief in something for which there is no evidence. Where there is evidence, no one speaks of “faith.” We do not speak of faith that two and two are four or that the earth is round. We only speak of faith when we wish to substitute emotion for evidence.” Bertrand Russell
“Faith is believing what you know ain’t so.” Mark Twain
So… if you don’t want to follow evidence, and make unjustifiable claims…call your self a priest, or a reverend. But don’t call yourself a doctor and give people hope. That is unethical!
I am all for the removal of the archaic term “subluxation”, I don’t treat it, just like I don’t treat leprechauns, or unicorns.
As for adding drugs and including prescriptions in Chiropractic… I am against that. That is what a referral is for.
RESPONSE From Frank:
Bart,
Well stated!
In general, I can say I agree with your comments. On another level, I wonder if you’re just tired of the School Bully beating up on you, so you’re buying into this form of evidence-chatter?
According to the Old War Dogs of Chiropractic, Ye Olde VSC involves 5 components.
Please answer the following questions truthfully:
These are all (obviously) loaded questions since we have peer-reviewed medical (scientific) research on our website that detail all these things. So…if you actually agree that these 5 things exist, then I wonder if you just don’t have the gumption to explain all that to whoever needs to hear it? That wouldn’t be scientific integrity…that’s just plain laziness.
Finally…if all that’s not a subluxation, do you have another term that more accurately describes these components?
To whoever replied to my thread:
The word subluxation is too encompassing. It not only addressed the components you mention, but everything else that ails the human body. According to DD and all his straight bedfellows, 95% of all ailments are due to subluxations of the spine, the other 5% are due to subluxations of the extremities.
“You don’t have cancer…your just subluxated, Your MD diagnosed you with AIDS..no no, you just have a subluxation that is not allowing your innate to fully express itself, here let me adjust your spine” PLEASE… show me the evidence.
“Straight Chiropractic is a vitalistic philosophy, science, and art which consists solely of the non-therapeutic objective of locating, analyzing and assisting in the correction of vertebral subluxations, because they are detrimental to the expression of innate intelligence” Federation of Straight Chiropractic
Non-Therapeutic??? Detrimental????
That is the archaic subluxation I am referring to. And that is why another term should be used to describe the 5 components you listed. Personally I don’t have a better term to describe them nor am I the person to come up with that term. I treat, I don’t do research unfortunately.
I do not deny any of those 5 components. You are correct…they are very real and have been documented with scientific research. (although I am not sure why you wrote it as “medical research”- what are you trying to imply there)
But they only deal with, and apply to the neuromusculoskeletal system. Not to overall immune system health and whatever other claims “straight” chiro’s say it affects.
There is no evidence that once your “subluxation” is gone your body will cure your cancer, diabetes, HBP…whatever. It only helps your NMS system, only this has been documented. It helps you increase your ROM, reduce your pain, and allow you to enjoy your day a bit more.
As for telling whoever needs to hear it how those components affect their everyday life..I do, but I wont claim that it will make them healthier.( in the all encompassing meaning of the word)
And finally, just to touch on the school bullying part of your comment…Im not sure how evidence based research- which is 1. logical, 2. reproducible, 3. tries to limit as many conflicting variables, 4. so as to show true cause and effect relationships,
can be thought of as a bully tactic.
It is pure and simple EVIDENCE.
How and when has evidence become the enemy to chiropractic. That is what we need more of. Don’t you want to tell your patients exactly what is going on and have it backed up by something more then anecdote? Then we wont have to make claims, because we will KNOW.
Anecdote is not evidence, but it is useful because it gives us a reason to further investigate a clinical phenomena, and to get to fully explain that phenomena.
As far as the “subluxation” goes, there is NO intra-examiner reliability when trying to locate a subluxation.(whether palpating or looking on X-rays) So how can it really exist?
RESPONSE From Frank:
That’s not really true. Researchers designed a novel study to test the accuracy of static and motion palpation by recruiting three subjects with single level congenital block vertebrae as testing subjects. Twenty fourth year chiropractic students examined their cervical spines, and the students scored substantial overall agreement for identification of the segment of greatest hypomobility. Because hypomobility is the hallmark (and first stage) of the subluxation model, your thesis is incorrect.
Admittedly, not much *real money* has been applied to chiropractic research, other than some trials for low back pain. Our profession only recently started developing a credible research infrastructure. Considering that our profession has been an ongoing victim of harassment and mis-information campaigns for most of the last Century, and because MDs were forbidden to teach or research with DCs, and because Federal Research dollars have only recently been injected (at homeopathic doses) into our budding research structure, it’s no big surprise that our research findings are sparse. The coming decades will tell the tale.
Researchers like Partap Kalsa and Chuck Henderson have published some significant work on tying joint hypomobility to degenerative changes and to radiculitis, both of which are significant components of the Subluxation Hypothesis.
If you dislike the term subluxation (for whatever misguided reasons) then call it something else. But don’t misguide yourself by believing that *most* DCs believe that “95% of all ailments are due to subluxations of the spine” because that’s just plain bull. DD Palmer wrote that 100 years ago, and it’s out of date now. You certainly never heard that in chiropractic school.
An Investigation into the Validity of Cervical Spine Motion Palpation Using Subjects with Congenital Block Vertebrae as a ‘Gold Standard’
BMC Musculoskelet Disord 2004 (Jun 15); 5 (1): 19 ~ FULL TEXT