When the ACA press release was distributed, calling the World Chiropractic Alliance a “fringe group” and accusing it of working with the medical establishment to defeat the VA bill, some doctors actually thought the ACA was telling the truth. They did not realize that the professional “spin doctors” at ACA headquarters had deliberately misrepresented the facts.
Christopher Kent, D.C., member of the World Chiropractic Alliance Board of Directors issued the following response to those doctors:
The news release from the ACA contains patently false and misleading claims. The ACA is attempting to rewrite history.
When the ACA/ACC draft of the proposed legislation was released, we were deeply concerned with several provisions. For example, D.C.s would be primary care providers only in “under-served” areas. The language also required only treatment for “musculoskeletal conditions.”
WCA merely asked D.C.s to contact legislators to insure the inclusion of direct access to subluxation-based care. The ACA/ACC proposal was not acceptable to us as written.
Ironically, the final VA proposal was NOT “torpedoed” by the WCA, but by the ACA/ICA/ACC coalition, because they found it unduly restrictive!
Furthermore:
1. WCA’s lobbyist has repeatedly attempted to work with the ACA and ACC. The ACA and ACC have not accepted our offer.
2. WCA has not been in communication with, much less worked with, the AMA, APTA, NACM, etc.
3. For ACA to suggest that WCA is a “fringe group” when the ACA represents only a small minority of U.S. D.C.s is a case of the pot calling the kettle black.
4. WCA is not the cause of the divisiveness alluded to, but one of the victims of ACA’s unwillingness to work with WCA’s Washington office to secure wording that would be acceptable to all parties.
5. WCA has not opposed the use of rehabilitative or physical therapy procedures, although we acknowledge that strategically, we must have a unique service to offer, and not merely be another provider of PT services. That is why we seek to INCLUDE subluxation correction. We have NOT sought to EXCLUDE the treatment of musculoskeletal disorder, PT, or rehab.
6. If the ACA/ACC/ICA would work with the WCA, I believe that we could draft legislation that would be acceptable to all of the organizations involved, allowing D.C.’s freedom of choice in how to practice.
Regretfully, the ACA has not exhibited candor in its claims regarding the WCA.
We will continue to take the high road, regardless of disingenuous accusations and name calling.
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DC FRCCSS(C) – Founder & CEO CLA Inc.
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By Dr. Christopher Kent
A disturbing trend is the willingness of some chiropractic researchers to abandon chiropractic terminology as well as chiropractic analytical strategies. The generic moniker “spinal manipulation” or “spinal manipulative therapy” is becoming a replacement for the term “chiropractic adjustment.” What’s wrong with that? They aren’t the same thing! There are techniques of chiropractic adjustment, such as basic, Grostic, etc. that simply do not fall under the medical definition of “manipulation.”
A popular definition of “manipulation” is “a manual procedure that involves a directed thrust to move a joint past the physiological range of motion, without exceeding the anatomical limit.” (1) The neurological implications of vertebral subluxation correction are not addressed in this definition.
A grave error is also made in many studies of the effects of “manipulation” by lumping all “hands on” techniques together, while failing to address key issues, such as the examination criteria used to determine the presence of “manipulable lesions,” and how the investigators determine that the “manipulative treatment” was successful.
Would it not be absurd for medicine to test the efficacy of drug therapy for a given disease without defining the diagnostic criteria for the disease and specifying which drug is given and at which dosage? It is no less absurd to collectively refer to all chiropractic adjusting techniques as “manipulative treatments” without defining the technique used, the force applied, the direction of the force, and the criteria for pre- and post-adjustment analysis.
Some researchers, who I will not embarrass by name, acknowledge that the side manipulated in their “studies” is determined by random assignment. Others arbitrarily “manipulate” a vertebral segment whether or not a “manipulable lesion” is present.
Research designs based upon the haphazard application of ill-defined interventions based on unreliable criteria can hardly be considered “scientific.” In his book, “How To Lie With Statistics,” Huff observed: “Permitting statistical treatment and the hypnotic presence of numbers and decimal points to befog causal relationships is little better than superstition…scantier evidence than this– treated in the statistical mill until common sense can no longer penetrate it–has made many a medical fortune and many a medical article in magazines, including professional ones.” (2)
The pain game
A number of chiropractors are also interested in research designs which compare the results of a diagnostic technology to patient symptomatology. The author considers such efforts dubious at best. For example, anatomical imaging modalities do not demonstrate pain. Some have criticized CT, MR, and fluoroscopic studies, claiming that many patients with reported abnormalities are asymptomatic. So what? CT, MR, and fluoroscopic studies simply demonstrate anatomy and pathology — they do not measure symptoms. How could any reasonable clinician expect them to? As has often been stated, “You can’t tell a living patient from a dead patient with an x-ray.”
Similarly, physiologic monitoring devices such as paraspinal EMGs demonstrate functional changes. Does the instrument measure pain? Certainly not. It is a mystery to me why anyone would think otherwise. Why squander our limited resources on research which attempts to correlate these procedures with pain? If a doctor wants to quantitate a patient’s perception of pain, why not use the simple and inexpensive “paper and pencil” tests these researchers are so fond of? Most proponents of these techniques have never claimed a correlation with pain. I am concerned that when it is “discovered” that these techniques do not correlate well with pain, such findings will be used in an attempt to discredit their utility.
Many well-meaning chiropractic researchers are putting the cart before the horse, and employing designs which are inherently flawed. In other instances, the research proposed is clearly designed to sell chiropractic care as a symptomatic treatment for musculoskeletal pain. Chiropractic is not a subset of medicine. Chiropractic is concerned with the detection and correction of vertebral subluxations. The courts and legislatures have, with few exceptions, maintained that chiropractic is not medicine, but is a separate and distinct science. As such, it has different objectives which necessitate different outcome assessments. Chiropractic and medicine share the objective of promoting human health. Their respective strategies for doing so, however, are radically different.
Some might argue that research is research, and that the same designs may be used by all scientists. That is precisely the point. As they say in the computer world, “garbage in — garbage out.” Competent research designs are dependent upon an understanding of the basic sciences, a working knowledge of contemporary analytic procedures, and an understanding of chiropractic philosophy. Appropriate outcome assessments must be employed, based upon an understanding of what the objectives of chiropractic care are. Interventions must be clearly defined. Criteria for the successful (or unsuccessful) application of an intervention must be defined.
What fruit has been borne by the allopathic research programs currently underway? The aberrant perception by students and some chiropractors that chiropractic is a subset of medicine, and that adjusting is a subset of manipulation? The perception that chiropractic care is temporary analgesia at best, and placebo therapy at worst?
The value of chiropractic research lies in its potential to improve our clinical strategies, and to provide us with a scientifically sound basis for making claims to the public and the scientific community. We cannot dismiss meaningful differences in culture and objectives as “just words.”
References
1. Bartol KM: “Osseous manual thrust techniques.” In: Gatterman MI: “Foundations of Chiropractic.” Subluxation. Mosby. St. Louis. 1995.
2. Huff D: “How to Lie With Statistics,” W.W. Norton, New York, NY, 1954.
Get Started with INSiGHT Scanning
Take our Free Practice Strategy Assessment. A Personalized Guide and Expert Strategy Call to Help Determine How Scanning will Help you Grow
Dr. David Fletcher is actively involved in all aspects of innovation teaching and research connected to the INSiGHT™ scanning technologies. He is widely recognized for his ability to share his expertise in compelling and easy to understand ways.
Dr David is a renowned chiropractor who practiced for many years with his associates in a scan-centric thriving principled family-based practice in Toronto. He is a sought-after teacher mentor and keynote speaker who takes every opportunity to share the wisdom and the power of chiropractic as it is meant to be.
Dr. David Fletcher
DC FRCCSS(C) – Founder & CEO CLA Inc.
LIKE THIS ARTICLE? HELP US SPREAD THE WORD
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