Chiropractic education: the battle continues

Chiropractic education: the battle continues

​For the past 5 years, SBM has been documenting the internecine wars among various factions of chiropractors over the Council on Chiropractic Education's (CCE) accreditation standards. This long-simmering controversy is bubbling up again as the CCE continues to draft, and redraft, its educational standards for chiropractic schools. 

The DC as PCP?

Dept. of Education to Council on Chiropractic Education: "Straighten Up!"

The Council on Chiropractic Straightens Up?

The issue is a basic one: what is chiropractic? Because various factions have very different views on the answer to that question, the challenges in drafting a set of rules for chiropractic education that everyone can agree upon are understandably formidable.

On one end of the spectrum, the traditionalists, or "straight," chiropractors, still believe that the "subluxation" is the foundation upon which one's health, or lack thereof, rests. This putative spinal lesion creates "nerve blockage," causing all manner of ill health. Chiropractic "adjustments" remove this blockage, thereby allowing the body to "heal itself." They distinguish the adjustment from spinal manipulation because only the adjustment, they say, has as its goal this restoration normal (if imagined) nerve functioning. Regular adjustments, also called maintenance or wellness care, are necessary, in their view, to prevent the untoward consequences of the subluxation settling in and creating yet another round of ill health. At the same time, they reject proven interventions that actually prevent disease, like vaccination.

On the other end of the spectrum are those who argue that the DC is qualified to be your primary care physician. They have crafted a more sophisticated but equally illusive iteration of the subluxation, and rechristened it with numerous other names, presumably to distinguish it from the straights' version. These chiropractors have pushed for a broadened scope of practice, reimbursement as PCPs, and, successfully in New Mexico, limited prescription rights.

The two extremes are ends of a continuum, along which chiropractors are free to stake their claim, choosing what they will from a menu of possibilities. For example, some chiropractors may offer sensible nutritional advice. To others, "nutritional advice" is based on bogus tests for imagined nutritional deficiencies, which can be conveniently remedied with dietary supplements sold by the chiropractor.

The CCE is now on a second draft of revisions of its 2013 accreditation standards. Once again, various factions are dueling over the role of the subluxation in chiropractic education.

The International Chiropractors Association (ICA), an industry group representing the straights, recently sent out an email stating its concerns over this latest draft. For one thing, the ICA is concerned that the current draft supports addressing the subluxation (or whatever you want to call it) only when the goal is "therapeutic." This fails to recognize that, in their view, maintenance care is necessary to good health. It is their version of preventive care, although without anatomical basis or evidence of effectiveness.

"ICA strongly supports the including of language that clarifies the appropriateness of chiropractic adjustment regardless of a patient's symptomology, when other clinical indicators of subluxation are present, To that end, ICA recommends the deletion of the term 'therapeutic' . . . as clinical goals are not always 'therapeutic.'" [Emphasis added.]

Another sticking point is the chiropractic "adjustment," a necessary tool, in their view, for correcting this non-existent subluxation.

"ICA recommends amending all sections to replace the term 'manipulation' with ...'other forms' of manual care. Other professions perform manipulations but only doctors of chiropractic administer chiropractic adjustments, with some chiropractic practitioners providing 'other forms' of manual care. This recommended language establishes far greater clarity on the unique role and responsibilities of the DC."

As well, the ICA continues to be concerned with the idea that chiropractors are PCPs. To this end, they want to make it clear that "primary care" simply means "portal of entry" and has nothing to do with the medical version of primary care. Thus, they want this definition included in the Glossary.

"Primary care chiropractic physician: A direct access, doctor level health care professional qualified to serve as the patient's first point of contact within the health care system, without referral from any other professional."

Finally, the ICA is leery of any requirement that inter-professional education and multidisciplinary clinical practice settings be included in clinical education. They want to be left alone to do their own thing.

They will be monitoring future developments in the CCE's work on accreditation standards "to establish educational standards that embody sound, chiropractic-specific terminology and procedures."

However this process unfolds, it will, as always, provide an interesting window into the internal workings of chiropractic and its seemingly endless struggle to decide just what that term means.

Points of Interest 11/01/2015
Points of Interest 10/27/2015

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