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Significant issues and developments related to chiropractic.

 

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Chiropractic

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"In a massive and historic outpouring by practicing chiropractors, students and patients, the chiropractic profession is demanding that the United States Department of Education consider a series of complaints being lodged by the profession regarding the governance of the non-profit group that controls accreditation of chiropractic schools - the Council on Chiropractic Education (CCE)…With their virtually complete control of the education and licensing of the entire chiropractic profession, the CCE has recently changed its Standards by which chiropractic educational programs are accredited. Those changes include the characterization of chiropractors as primary care physicians while removing the designation of chiropractic as occurring without drugs and surgery. Most significant is the complete removal of the chiropractic profession’s reason to be – the vertebral subluxation….This has set up a perfect storm for a battle between those within the profession who wish to give up their traditional, conservative practice to take advantage of a broader scope through a merging with medicine and those who wish the profession to remain separate and distinct from organized medicine and keep its focus on the analysis and correction of vertebral subluxation.” Press release (12th September 2011)

Update: 22nd November 2011 - The Council on Chiropractic Education (CCE) publishes an open letter to the chiropractic profession. [PDF]

Update: 30th December 2011 - When the Council on Chiropractic Education (CCE) published its proposed 2012 Accreditation Standards for chiropractic colleges, reference to the word “subluxation” was omitted. The American Chiropractic Association (ACA) responded, in part, arguing that “The elimination of any reference to this term in the proposed standards will be viewed by many within the profession as a counter productive action that will, in the long-term, likely weaken the profession’s collaborative strength and historical identity.“ The CCE compromised by using the nebulous phrase “subluxation/neuro-biomechanical dysfunction” in the final 2012 Standards in order to satisfy advocates of the vertebral subluxation theory. (An open letter to the profession from CCE, Nov 22-11 – see above) Obviously, the factory of the chiropractic profession has not discarded subluxation theory. Chiropractic associations continue to reflect the views of the majority, even if such views are based on a belief system.

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With the recent adoption of new informed consent requirements for California chiropractors, the California Board of Chiropractic Examiners has joined the ranks of only a few chiropractic regulatory agencies in the [U.S.] to require its licensees to inform patients of potential risks of their treatment.  The new law, which goes into effect on Oct. 7, 2011, requires chiropractors to obtain patient consent prior to providing any treatment that could pose a risk of harm to the patient. Specifically, this regulation will do the following:

  • Require all licensees to inform each patient, verbally and in writing, of the material risks of proposed care (defining "material" as a procedure inherently involving known risk of serious bodily harm)
  • Require the licensee to obtain the patient's written informed consent prior to initiating clinical care
  • Provide that the signed written consent shall become part of the patient's record
  • Specify that a violation of the above requirements constitutes unprofessional conduct and may subject the licensee to disciplinary action

Dynamic Chiropractic (12th September 2011)

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Preview chapter of Darryl Cunningham’s upcoming Science Tales book, which will be published by Myriad Editions in 2012. (19th August 2011)

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“In a closed door meeting, the licensing panel of the Colorado Medical Board found ‘evidence’ chiropractor Brandon Credeur performed the ‘unlicensed practice of medicine’ and referred the case to the Attorney General for legal review.” Denver news report (19th August 2011)

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“Currently, there is no way to determine whether one may be at risk, making chiropractic neck manipulation akin to playing Russian roulette. One of the greatest myths ever is that stroke and death due to chiropractic neck manipulation is a rare and unfortunate side effect of a ‘valuable treatment’. In fact, 99.9 per cent of all chiropractic neck manipulations have nothing to do with treating neck pain, or any other musculoskeletal pain but by the unproven, non-scientific belief system that chiropractic upper neck manipulation is a cure for every disease…Even going to a chiropractor for musculoskeletal pain can cause stroke, therefore, it is recommended that you never let a chiropractor touch you above the shoulders.” Sharon Mathiason, The StarPhoenix (18th August 2011)

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“In a public talk, the Sydney chiropractor linked vaccines to asbestos, thalidomide and cigarettes, and said they contained bits of aborted fetus. The chiropractor backed the debunked research of deregistered British doctor Andrew Wakefield - which suggested the measles, mumps and rubella vaccine might cause autism - as ‘scientifically good’. The parents and pregnant women who attended the talk in March were told ‘homeopathic vaccines’ - which are regarded as scientific nonsense by most experts - were safer than conventional vaccines. The comments by Nimrod Weiner, who is vice-president of the Chiropractors Association of Australia (NSW), were recorded by Australian Doctor. They were condemned as ‘outrageous’ yesterday by the Australian Medical Association…Mr Weiner declined to comment, referring questions from The Australian to a PR company, which said the Chiropractors Association of Australia (NSW) had no position on vaccination and "any comments that Nimrod Weiner may have made would be his private opinions, not those of the association".” Australian press report (17th August 2011)

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“Doctors have accused some chiropractors of undermining public health policy by supporting a discredited anti-vaccination group and directing patients to the site for information. Chiropractors are the biggest professional supporters of the anti-vaccination group the Australian Vaccination Network (AVN). Last year, the Health Care Complaints Commission issued a public warning about the AVN after it found the group was spreading misinformation about childhood vaccination. The AVN refused to comply with the HCCC's recommendation that they place "a statement in a prominent position on its website" outlining their anti-vaccination stance and was subsequently stripped of its charitable status. Of the network’s 198 professional members, 128 are registered chiropractors. Many are members of the professional body the Chiropractor’s Association of Australia, or CAA…Dr Brian Morton from the Australian Medical Association said it was “reprehensible (some) chiropractors support the anti-vaccination lobby” and they should not have access to Medicare rebates and taxpayer subsidies from private health insurers…The Chiropractors Association of Australia refused to take an official position on vaccination and told news.com.au that the Chiropractors’ Association of Australia (NSW) did not have an official position on vaccination…Rachael Dunlop, a biologist, attended a vaccination information seminar held by Newtown chiropractor and CAA NSW vice-president Nimrod Weiner six months ago. “Over two hours we were told that vaccinations caused autism and brain damage and as we were leaving we were given a pamphlet that said ‘18 reasons not to vaccinate',” the 40-year-old from Petersham said…The AMA called on Federal Health Minister to review Medicare payments to chiropractors who supported the anti-vaccination lobby.” Australian press report (27th July 2011)

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“Members of the Korean Chiropractic Association [KCA] in South Korea are in uproar at the scrutiny of their profession, after an investigation of formal Chiropractic clinics by local health authorities has led to more legal proceedings…Under the law, It is illegal for independent Chiropractors to practise. If you were a Medical Doctor who took some seminar classes in Chiropractic or similar manipulative therapies, you could legally practice those techniques, however, someone who just went to a Chiropractic college in America, the UK, or Australia could not legally practice in Korea…Appeals from the Members of the KCA claim that the law is unconstitutional, however, while this defence erroneously characterizes the law as being "anti-Chiropractic", South Korean law doesn't state that Chiropractic is illegal. Rather, the law states Chiropractors can't practice their techniques unless they're qualified Medical Doctors.” Bayani Mills, Birmingham Skeptics (18th July 2011)

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Canadian rocker, Alannah Myles, explained to her audience how she had overdone chiropractic treatments, having some 500 treatments over three years, and had suffered some severe spinal damage. Canadian press report (1st July 2011)

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Police want to know what happened to 30-year-old Jeremy Youngblood. His father told police he died after getting a neck adjustment. His family claims that during the appointment…Youngblood began vomiting and sweating profusely. The medical examiner said he later died from a stroke caused by manipulation of the neck. His family hired an attorney. “Once I conclude the investigation and the facts are as I think they are, we will be vigorously and aggressively prosecuting a death claim on behalf of Jeremy Youngblood,” said Leo Austin, Youngblood’s attorney. Oklahoma press report (22nd June 2011)  Jeremy Youngblood's Death Certificate and Autopsy Report can be viewed here [pdf].

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“Details of the settlement aren’t being released, said Amani Oakley, the lawyer for Joe Labonte of Guelph whose wife, Dora, died of a stroke in July, 2002, several weeks after a chiropractic treatment.” Canadian press report (28th March 2011)

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The request has been made on the basis that the Royal Melbourne Institute of Technology (RMIT) Chiropractic Paediatric Clinic is “teaching inappropriate and potentially dangerous techniques that target pregnant women, babies, infants and children”. The 20-page document submitted by Loretta Marron, a long standing campaigner against pseudosciences in health, includes expert opinion from high profile and well-regarded Professors of Medicine relating to supposed efficacy of chiropractic; identifies the claims made by lecturers and graduates from RMIT and other chiropractic teaching institutions; identifies the relevant codes of conduct that are breached by graduates; identifies research relating to spinal manipulation on a wide range of health conditions; refers to the General Chiropractic Council (UK) on comments on ‘subluxations’ and evidence-based practices; refers to the HCCC anti-vaccination campaign, which is supported by over 120 chiropractors; refers to a recent US-based court case which limits chiropractic diagnoses to biomechanical conditions of the spine and musculoskeletal system; and recommends that the competency and education standards for chiropractors be reviewed. (16th March 2011) [PDF]

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Three members of the Connecticut Board of Chiropractic Examiners are caught breaking the law and the state Department of Public Health orders compliance. Their response?  Lobby the legislature for a bill to change the law.  Newhaven Independent (8th March 2011)

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“A report by Dr. Steven Welsh of the Georgia Chiropractic Council indicates that the Council on Chiropractic Education has seemingly ignored the overwhelming input from the profession at large.  In September 2010, the CCE Task Force on Accreditation Standards released a second draft to the public for comments. At the latest meeting Jan. 14, the CCE met and adopted new educational standards that will become effective in January of next year.  Welsh, who attended the public proceedings, reports that the CCE President announced that the Council had received two complaints. No details were provided. Council members were reminded of the need for complete confidentiality.  In October 2010, it was reported by Welsh that the CCE had received approximately 3,000 submissions from the profession.  During their annual business meeting last Friday, the CCE reviewed and approved the 3rd draft submitted by the Task Force, which included multiple amendments by individual council members. One proposed amendment was not approved by the council. Based on feedback from the chiropractic profession, Dr. Guy Riekeman suggested that the new standards include a reference to the foundational concepts upon which our profession is based…After a discussion of the fact that the CCE doesn't support any specific philosophy and a comment from one council member that subluxation is not evidence informed, the council overwhelmingly defeated the motion.” Chiropractic Economics (25th January 2011)

UPDATE 1 - March 2011: Hundreds of chiropractors sign a petition aimed at stopping the CCE from redefining chiropractic.

UPDATE 2 - March 2011: US Council on Chiropractic Education (CCE) makes only "minor" revisions to draft standards.  (Changes in force from 2012.)

UPDATE 3 - Summary of September to December 2011 developments.

UPDATE 4 - Summary of the CCE's one-year recognition renewal granted in December 2011: "The Council on Chiropractic Education (CCE), the sole agency recognized to specifically accredit chiropractic colleges in the United States, was given a one-year renewal of its status with the Department of Education (DOE) after being presented with a list of 42 “issues or problems” it must address within the coming year. The National Advisory Committee on Institutional Quality and Integrity [NACIQI] spent more than four hours on Dec. 14, 2011, hearing from CCE supporters and detractors before making its decision on the agency, which has come under fire for making major changes in its Accreditation Standards last year. The CCE’s changes eliminated all reference to subluxation, removed the term "without drugs or surgery" from the description of chiropractic and asserted its authority to accredit any program it deems to be "equivalent" to the current DC program…The Committee did make it clear that it “is not the Department’s responsibility to take sides in this ongoing philosophical discussion,” and that many of the charges leveled against the CCE were not related to the Secretary’s Criteria for Recognition, which is the sole standard by which an accrediting agency may be evaluated. It did, however, note that the CCE “did not provide evidence of its consideration of all comments it received during the course of its standards review process. It should be noted that an agency is required to consider all comments, but is not required to implement all of the comments or suggestions it receives.” Twenty individuals appeared as commenters during the meeting…Speaking in opposition to the CCE’s new standards were the International Chiropractors Association, the International Federation of Chiropractors and Organizations (IFCO), the Movement for Chiropractic Quality and Integrity, the Georgia Council of Chiropractic, and the Foundation for Vertebral Subluxation, among others."

UPDATE 5 - Anti-subluxationist elected as the Chair of the CCE: Craig Little DC, DABCO, a member of the affirmed anti-subluxation West Hartford Group, ran unopposed for the position of Council Chairman on 13th January 2012.

UPDATE 6 - May 2012: The Truth About CCE: What really happened with NACIQI and USDOE  Fact: The term “subluxation” was not removed from the 2012 CCE Standards; Removal of “without drugs or surgery” from the 2012 CCE Standards…Primarily, the language was removed because it is inaccurate and misrepresents reality. Drugs and surgery are a part of the chiropractic profession and have been for at least 108 years. As difficult as it may be for some to accept this fact, it is nevertheless, true. At least one chiropractic college teaches minor surgery in its core curriculum and has done so continuously for decades. Some other chiropractic colleges either offer minor surgery as an elective or as a continuing education program. At least one state licensing board requires 36 hours of instruction in minor surgery as an eligibility requirement for licensure in that jurisdiction. As for “drugs,” this is a much more difficult and complex issue to address because the term “drug” needs further refinement and definition…Vitamins, minerals, supplements, medicinal herbs, nutraceuticals, etc., any or all of which are taught at some chiropractic colleges and used specifically to influence human physiology, certainly qualify under the broader definition of drug. Compounding this issue is the use of over-the-counter, non-prescription aids, many of which were at one time controlled, prescription items…Therefore, it is accurate to state that chiropractic practice does include at least some degree of both the practice of minor surgery and the use of drugs; Disregard of input from the chiropractic profession during the CCE Standards review process: Fact: During its evaluation of the CCE, USDOE staff reviewed: memos, emails and meeting agendas of the Standards Review Task Force (SRTF); minutes of CCE Council meetings regarding SRTF actions and activities; a timeline of the review process; announcements for public comment, actual comments submitted and CCE staff reviews of public comments; and memos demonstrating the process of how all comments received were reviewed for consideration. Additionally, USDOE staff was provided factual details regarding the letter writing campaign for which opposition has given so much importance; Other facts: Contrary to widely held belief among the CCE opposition, it is not the responsibility of the CCE to represent the profession – this is the function of professional trade organizations (ACA, ICA, etc.). Further, the authority to define the profession and to establish the scope of practice remains with the jurisdictional licensing authorities and legislatures of each state. The CCE is responsible for ensuring that doctor of chiropractic degree programs provide an educational program that is characterized by quality and continuous improvement. Of the 54 US jurisdictions (including District of Columbia and three territories), 45 boards directly reference the Council on Chiropractic Education in their laws (statutes and/or regulations) while the other eight Boards indirectly reference CCE (most often as “a chiropractic accrediting agency recognized by the USDE.”) In the end, the staff of the United States Department of Education saw through the misrepresentations and faulty claims made by those in opposition to CCE. [American Academy of Chiropractic Physicians website] 

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Kaiser Permanente, which provides health care plans for more than 8 million Americans, operates through regional divisions. In July, in a move with serious implications for the chiropractic profession, Kaiser Permanente Mid-Atlantic States and Mid-Atlantic Permanente Medical Group decided to exclude cervical chiropractic manipulative treatment (CMT) from coverage.  The American Chiropractic Association responded swiftly and…Kaiser Mid-Atlantic has suspended its decision and reinstated coverage.” p.16, Quarterly World Report, World Federation of Chiropractic (31st December 2010) [PDF]

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Spain: The Spanish Chiropractors´ Association (AEQ) has started a project with the objective of seeking legislation. Sweden: The Swedish Agency for Higher Education has presented a report for the Government proposing that chiropractors should first become physiotherapists, then add an extra two years to become chiropractors. Norway: The Ministry of Education has been given the task by its government to make a report on how to establish a chiropractic university program in Norway, and how to establish research within the chiropractic field in Norway. After the development in Sweden, there is some concern about the content of this report. Germany: An initiative is being made towards establishing a chiropractic education at a university in Germany. Luxembourg: The chiropractic association of Luxembourg has scheduled a meeting with the European Chiropractors Union (ECU) President for the 2nd weekend of January 2011. Focus will be on organization, legislative initiatives and development of chiropractic in Luxembourg. France: The French Chiropractic Association has taken some major steps towards recognition and regulation. If everything goes according to plan, chiropractic will have a new law in France in 2011. Great Britain: Early professional conduct cases arising from mass complaints made by UK skeptics have resulted in not guilty verdicts. In particular, the Professional Conduct Committee accepted the argument that chiropractic care extends beyond the narrow focus of manipulation, massage and mobilisation that was the subject of the Bronfort Report. It has also accepted that an indication on a website that chiropractors treat named conditions is not potentially misleading, nor does it exploit the public's lack of knowledge about chiropractic. Many more cases will follow in 2011. The Netherlands: The Dutch Chiropractic Association has decided to make the position of president a paid position which will further the professionalisation of the Dutch Chiropractic Association. Croatia: The President of the Croatian Chiropractic Association will apply for ECU membership next year. Hungary: The Hungarian Chiropractic Association is in the middle of a process of getting the association officially registered in the country. ECU membership will be applied for as soon as the registration process is completed in Hungary. (December 2010)

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“This an important achievement for the school and equally important for the chiropractic profession because the principal goal of the profession is to assure the quality of chiropractic undergraduate education and training against a set of educational standards. The Barcelona College of Chiropractic [BCC] is a public university affiliated college of chiropractic and registered with the Catalan Government's Justice Department via a non-profit foundation.” Øystein Ogre, European Chiropractors’ Union President (18th November 2010)

UPDATE - 1st June 2011: It is important to note that the Barcelona College of Chiropractic is not recognised as a University by the Spanish Ministry. The complete list of recognised Universities can be checked here or via the Spanish Ministry directly.   The BCC course, and title awarded -"Título Superior en Quiropráctica del Barcelona College of Chiropractic – Escuela Superior Internacional"- is not recognised as an official title by the Spanish Ministry. This can be checked here (note that the BCC or "quiropráctica" are not even mentioned there).  Although the BCC has signed collaborative agreements with Universidad Pompeu Fabra (UPF) and Universidad de Girona¨(UG), neither UPF nor UG assume, recognise, or endorse the title. This can be checked on their respective sites here and here.  The agreements seem to be aimed only at allowing the BCC to use some facilities of the Universities (see here).  Although all foundations must be "government registered" under Spanish Law, this does not mean any sort of official endorsement of their activities.  In fact, the BCC carefully avoids to present itself explicitly as a "university". The claim is made by third parties, such as the Spanish Chiropractic Association, that the BCC presents as "Institutional Support". The association claims that: "Pese a que aún queda mucho camino por recorrer, estudiar quiropráctica en España ya es posible desde 2007 gracias a la creación de dos titulaciones universitarias de grado superior: la primera, en el Real Centro Universitario Escorial-María Cristina (San Lorenzo de El Escorial, Madrid), y el Barcelona College of Chiropractic, que echó a andar el pasado año. En ambos centros universitarios, se necesitan cinco años de estudios, además de un último curso de prácticas para poder ejercer la profesión". [TRANSLATION: "Although there is still a long way to go, to study chiropractic in Spain is now possible since 2007 with the creation of two **university degrees** in higher education: the first in the Real Centro Universitario Escorial-Maria Cristina (San Lorenzo de El Escorial, Madrid), and the Barcelona College of Chiropractic, which took off last year. In both **universities**, it takes five years of study, and a final year to practice the profession.]

NOTE: Adrian Wenban, B.Sc.(Anatomy), B.App.Sc.(Chiropractic), M.Med.Sc.(Clinical Epidemiology), MACC, Principal, Barcelona College of Chiropractic, claimed in private correspondence on 1st June 2011 that the BCC "is a private college with strong public university affiliations. In addition the BCC is the property of a non-profit government registered foundation, called the Fundacio Privada Quiropractica (FPQ). The FPQ is registered with, and recognised by, the Catalan regional government's Justice department. The BCC is not, and never has been 'under investigation' for inappropriately using the title 'University'."

UPDATE summary - 27th June 2011: The Spanish government does not recognise chiropractic as a health profession or as an official degree. The government accepts some foreign titles, but not to practice as a chiropractor, only as a physiotherapist. Although some chiropractors claim that there are two chiropractic college degrees in Spain, none of them is official. The Barcelona College of Chiropractic (BCC) is a private institution, not recognised as a university by either the Catalan regional government or by the Spanish government, and its title has no official status. The Real Centro Universitario Escorial-Maria Cristina (RCU) has been licensed only to give a Degree in Law, backed by the Universidad Complutense de Madrid, but its other degrees are not official. Currently, the RCU is being investigated by the Madrid regional government for offering its degree in chiropractic as a "University Degree". In fact its website now makes it clear that the degree is of private character and unofficial. With regard to the AEQ, it is a private association that does not have any official status.

UPDATE - 4th August 2011: Chiropractors to be recognised and regulated under the Spanish Health System.  The Minister for for Health, Leire Pajin, announced in the Senate that in September the final list of natural therapies recognised and regulated by the National Health System will be released. Among theme is chiropractic… “The AEQ (Asociacion España de Quiropractica) has been working hard over the past 20 years to promote the highest standards of chiropractic care and to protect the name of chiropractic. The recognition of chiropractors in Spain is a big move towards full legislation, exactly as in the UK, where it is illegal to use the title ‘Chiropractor’ without having a full Master’s degree…Chiropractic, born in the United States in 1895, is recognised in the legislation of all European countries except Greece, Luxembourg and Spain, and in Spain there are currently circa 200 professional practitioners.”