Statement on Policy & Chiropractic
Whether one realizes it or not policy decisions at every level affect the way we live, how we live and even if we live. In health care, questions of policy are paramount because in many cases the policy in question has been developed by a third party who is paying for the care. Whether this is the government, an insurance company or an employer their policies dictate whether or not chiropractic care is provided. And while it is easy to brush these concerns aside and suggest that one just go outside the system and transact directly with the practice member – it isn’t that simple.
Policy decisions by others regarding the role of chiropractic spill over into every aspect of care decisions. These policies influence how the consumer views chiropractic and thereby how and to what extent they engage us as their provider. Thus far, in terms of policy, the profession as a whole has sought to position itself as a cost effective alternative for the treatment of back pain. This is due to the fact that certain individuals, organizations and businesses within the profession decided to focus their policy efforts in this area. While this cartel comprises only a minority, splinter faction of the profession, they control the most significant regulatory, organizational and corporate bodies within the profession.
The subluxation based community on the other hand has abdicated its roles and responsibilities in the area of policy and as such subluxation based care is often portrayed by the controlling faction of the profession as a threat to public health. We see this manifest in policies that summarily reject a subluxation diagnosis as the sole rationale for care. We see this in policies that condemn and disallow prepayment plans and long term care planning for the correction of subluxation. We see this in policies that reject the use of radiographs to identify the misalignment component of vertebral subluxation and their use to acquire a vector necessary to reduce that misalignment. We see this in policies that restrict, disallow or condemn a vitalistic, non-therapeutic or meta-therapeutic approach to health and well being.
Overall, the controlling faction of the profession has sought to marginalize, and in many cases criminalize, a subluxation based, vitalistic approach and substitute for it a more narrow, musculoskeletal oriented approach focused on the short term amelioration of pain syndromes and management and treatment of disease in an allopathic model.
Unfortunately one of the responses to this attack on subluxation has been a move to abandon the term subluxation and focus instead on the adjustment and to refocus subluxation based chiropractic as “neurologically based” chiropractic. Sadly much of the research that is touted as focused on subluxation doesn’t use the term and the belief has circulated that the input to the nervous system from the adjustment is all that’s needed. This belief reveals a deep seated misunderstanding of chiropractic, has nothing to do with science and everything to do with political expediency.
These policies have metastasized into every aspect of the profession including accreditation, regulatory agencies, state boards, state, national and international associations, testing agencies, the insurance industry, government programs, education, and research.
When looked at very closely however, one can see that this same small, controlling cartel within the profession is at work in every one of these areas. Again, this is due to the apathy and disengagement of the subluxation based community when it comes to developing, refining and implementing policy. It is time for the subluxation based community to seriously engage in matters of policy that affect the profession. A small, rogue splinter group has sought to fundamentally alter the very substance of the chiropractic profession in just a short time period.
It is time for the majority of the profession which identifies with a subluxation based approach to exert itself and formulate, develop and implement policies that are congruent and supportive of the foundational principles and tenets of the profession.
Will you join us on this mission?
CHIROPRACTIC CARE & RADIOGRAPHS/IMAGING
Foundation Policy Position Statement on Chiropractic & Radiographs/Imaging
The Foundation for Vertebral Subluxation encourages an evidence-informed approach to the use of radiography in the assessment of vertebral subluxation.
Doctors of chiropractic are responsible for determining the safety and appropriateness of chiropractic care. This responsibility includes the detection and characterization of vertebral subluxations, congenital and developmental anomalies which may affect the selection of chiropractic techniques, and conditions which may contraindicate certain chiropractic adjusting methods.
Furthermore, radiography may disclose conditions requiring referral to another type of health care provider.
CHIROPRACTIC CARE & STROKE
Foundation Policy Position Statement on Chiropractic & Stroke
There is no human experimental evidence that chiropractic adjustments or neck manipulations are causally related to strokes.
The claims and statements that have been made and that have been interpreted by plaintiff attorneys and plaintiff experts to contend a link are based largely on anecdotes, case reports, and case controlled studies.
A multitude of systematic distortions (biases) may effect the results and conclusions drawn from case-control studies. Other criteria must be used to determine whether a purported association is actually causative because an association does not prove causation.
At this point in time due to the rarity with which vertebrobasilar accidents occur within this population, experimental evidence in humans and prospective cohort studies examining the hypothesis that chiropractic adjustments cause stroke – do not exist.
In fact, recent research shows no evidence of excess risk of VBA stroke associated with chiropractic care as compared to primary care.
Regarding advising on risks – a risk should be disclosed if a reasonable patient in what the doctor knows or should know to be the patient’s position, would be likely to attach significance to the risk or cluster of risks in deciding whether to forego the proposed therapy.
Patients and doctors must make this decision based upon appropriate information. Since there is no human experimental evidence that chiropractic adjustments or neck manipulations are causally related to strokes, it is inappropriate to require a doctor to suggest that such a risk exists.
Further, chiropractors utilize a number of techniques to address joint dysfunction and vertebral subluxation. Many techniques do not employ the type of manipulation that has been alleged to be a factor in vertebrobasilar accidents. This adds to the inappropriate nature of such a disclosure.
TIERING OF THE PROFESSION
Statement Regarding Tiering of the Profession
A Masters Degree in Advanced Clinical Practice is being promulgated within the profession which purports to give chiropractors a broader immersion in clinical studies including pharmacology. It is reported that the National Board of Chiropractic Examiners is planning to develop a certification exam for anexpanded practice chiropractic physician, New Mexico has recently added such an advanced practice designation to their statute and the American Chiropractic Association has recently voted to endorse such efforts.
The Foundation for Vertebral Subluxation has serious concerns about the development of designations to chiropractic credentials through additional degrees or otherwise which denote a superiority to licensed doctors of chiropractic and amount to defacto tiering of the profession. Beyond the simple uncollegiality of such designations there may be serious legal, ethical, regulatory and accreditation implications for such designations. Beyond the connotation of superiority and the tiering that arises out of such designations, the push to include pharmaceuticals into the scope of chiropractic practice is the most serious issue facing the profession. Chiropractic is not the practice of medicine and is in fact a distinct and separate profession that enhances the ability of the body to heal without the use of drugs and surgery.
The Foundation urges all chiropractors, chiropractic associations and organizations to join together and oppose these actions.
DRUGS IN CHIROPRACTIC
Policy Statement on Drugs in Chiropractic
There is general agreement throughout chiropractic that we are a drugless profession. The Association of Chiropractic Colleges Paradigm, adopted by most major chiropractic organizations including the ACA, ICA, and WFC, states emphatically:
“Chiropractic is a health care discipline which emphasizes the inherent recuperative power of the body to heal itself without the use of drugs or surgery.”
Yet there is an insidious movement within our profession to override the consensus of the majority of the chiropractic colleges, organizations & practitioners that serve our profession and incorporate the use of prescription drugs, including injectables, into patient care.
It is the position of the Foundation for Vertebral Subluxation that the inclusion of drugs within the chiropractic scope of practice would be contrary to the historic and widely accepted identity of the profession.
While some chiropractic schools have offered postgraduate courses in injectable nutrients and local anesthetics, few, if any, accredited chiropractic colleges provide instruction on the use of prescription drugs, including injections of homeopathic medications, hormones, prolotherapy agents, etc. No chiropractic college clinic employs injectable homeopathic remedies, injectable nutrients, and other legend drugs in the care of outpatients in their teaching clinics.
Furthermore, students have no hospital rotations and practical training in dealing with anaphylactic reactions and other adverse effects.
Homeopathic medicine is highly controversial. Furthermore, only three states separately license homeopathic physicians (Arizona, Connecticut and Nevada). They require that an applicant hold a medical degree, complete residency training, and have specialty training in homeopathy.
All homeopathic injectables and some oral products are prescription drugs. To have marginally trained DCs practicing an entirely different system of medicine is not in the best interests of the profession or the patient community. The expansion of drugs into the scope of chiropractic practice would result in an increase in professional liability insurance premiums and the public image of the profession would suffer, as chiropractors could become perceived as third-rate medical practitioners, sometimes using very questionable drugs and medicines.
Chiropractors would become part of the iatrogenic drug problem and chiropractic’s impressive safety record could become a thing of the past.
Tiering of the chiropractic profession that would result from the introduction of drugs would lead to two (or more) classes of chiropractors, causing a level of splintering and divisiveness the intensity of which the profession has never experienced.
For the reasons outlined above, the Foundation for Vertebral Subluxation is opposed to any effort that seeks the addition of drugs into the scope of chiropractic practice and calls on all professional organizations and practitioners to reemphasize the definitive paradigm of the profession.
Vertebral Subluxation as the Sole Reason for Care
The Foundation for Vertebral Subluxation holds that the unique role of the chiropractor is separate from other health disciplines and that the professional practice objective of chiropractors may be limited to the analysis, correction or stabilization of the subluxation.
State laws, the federal government, international, national and state chiropractic organizations and the Association of Chiropractic Colleges all define the unique and non-duplicative role and responsibility of chiropractic as focusing particular attention on the subluxation and its resultant compromise of neural integrity.
The use of subluxation as a rationale for care is supported by protocols that are safe, efficacious, and valid. The literature is sufficiently supportive of the usefulness of these protocols in regard to chiropractic examination and analysis.
The chiropractor uses a variety of procedures to assess the vertebral subluxation in order to determine its presence and arrive at an impression of its location, character, type, and chronicity.
Management of subluxation from a vitalistic perspective is applicable to any patient exhibiting evidence of its existence regardless of the presence or absence of symptoms and disease.
Therefore, the determination of the presence of subluxation may stand as the sole rationale for care. Nothing in this position statement absolves the chiropractor from knowing the limits of his or her authority and skill, and from determining the safety and appropriateness of chiropractic care. The chiropractor has a duty to disclose to the patient any unusual findings discovered in the course of examination, and may collaborate with other health professionals when it is in the best interests of the patient.
Community Adjusting (Open Adjusting Plans)
The concept of “open” or “community” areas where health care is provided is not unique to chiropractic. This style of practice is found in such diverse areas as physical therapy, orthopedics, emergency rooms and psychotherapy.
The concept of open areas for the provision of care is not simply an efficiency issue. The role of community in healing and the empowerment that it brings may be central features in a practice member’s recovery and the ability of the doctor to facilitate healing. In addition to this there may be less likelihood of allegations of inappropriate touching or sexual misconduct in a group setting.
Any attempts by regulatory boards to encourage or impose sanctions upon chiropractors merely for offering and making available such opportunities to patients must be vigorously opposed.
In consideration of the above, the Foundation for Vertebral Subluxation affirms that open/community adjusting areas are an acceptable standard of care for the practice of chiropractic. The Foundation has adopted the Recommendation of the Council on Chiropractic Practice on this issue as contained in the 2003 Clinical Practice Guideline Number 1: Vertebral Subluxation in Chiropractic Practice. The wording is reproduced here in its entirety:
Respecting patients’ right of privacy has always been both an ethical and a legal duty. New federal regulations place specific, enforceable obligations on most chiropractors and their employees. Knowledge of and compliance with these regulations is essential in order to
remain in practice.
It is acceptable for chiropractic care to be provided in a setting where more than one patient receives care in the same room. In such a case, the patients involved must consent to this arrangement. The chiropractor should have procedures where a patient who wishes to be examined or adjusted privately may do so.