A chiropractic definition for our millennium


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Issue 3 - March 2004

A chiropractic definition for our millennium
By Robert Jusino, DC, MPH

The chiropractic journals are filled with passionate and heated debate over our profession’s definition, with calls from many different groups of leaders to unite the profession. It is quite sad that a profession more than one hundred years old with so many health benefits to offer is still struggling to define itself and is so misunderstood by the public.

Let us look at what we have in common with each other — as well as our differences. Then, perhaps, we can come up with a solution that will acknowledge and respect those differences and allow us to work at peace with each other for the good of our profession and the public health.

Our common grounds

First let’s examine what we have in common:

• Our history. All doctors of chiropractic have a common history with our founder D.D. Palmer, his son B.J. Palmer and their theories of health and disease. Central to our profession is the founder’s belief that when traumatic nerve interference, toxins and negative autosuggestions are removed, the human body’s innate mechanisms and recuperative powers will maintain biological homeostasis and health. These early chiropractic health beliefs have common ground with modern day holistic health approaches that promote the mind-body connection, physical fitness, nutrition and exercise.

• Educational foundation. At present, doctors of chiropractic share common ground in their educational experience. Because of the Council on Chiropractic Education (CCE) accreditation requirements, all chiropractic students take a similar curriculum of basic sciences, clinical sciences and chiropractic techniques.

• Licensing standards. Although schools differ on pre-admission requirements, with some requiring only two years of college and others up to four years of college, all students must pass board examinations administered by the National Boards of Chiropractic Examiners (NBCE) in order to be licensed chiropractic practitioner.

• Agreement on basic elements of a definition. Just as common ground exists in the education of chiropractors, it also exists among the various definitions of chiropractic purported by different organizations, such as the Association of Chiropractic Colleges www.chirocolleges.org), the American Chiropractic Association (www.amerchiro.org) and the International Chiropractors Association (www.chiropractic.org). (Check each organization’s Web site for complete definitions.)

Although differences in language exist, all of these definitions agree on:

• The importance of the body’s natural (innate) recuperative powers and the notion of promoting optimal wellness;

• The theory of vertebral segmental dysfunction (subluxation) and its effects of human health;

Why we need a new definition

The chiropractic profession is losing the window of opportunity created by the healthcare industry's recent interest in spinal manipulative therapies.

Many threats loom over the future of the chiropractic profession.

• The physical therapy and osteopathic professional threats. The osteopathic profession has resurrected its elective Osteopathic Manipulative Therapy courses (OMT) and is adding them to their “mandatory” core curriculum. OMT used to be elective courses. Family medicine residents will be board certified in family medicine and OMT.

The physical therapy profession has raised its educational standards and is including orthopedic manipulative therapy as a specialty. Physical therapists are studying to become doctors of physical therapy, DPT.

Doctors of chiropractic have survived and flourished in the past but we did not have competitors offering similar services.

• Limited reimbursement. The many insurance caps and lack of coverage for chiropractic services are an expression of isolation from the system, an apparent lack of relevance and a limited definition of the chiropractic scope of practice.

The criticized limitation of the Medicare system, which one day could be our national healthcare system, reflects the “straight” camp view — detecting and correcting subluxations. The chiropractic services of “correcting subluxations” are probably not well understood by the plan’s administrators and its beneficiaries. These services are mandated by the Medicare Act but are greatly underutilized and are presently being reviewed in litigation at the federal court system.

The purpose of exams and x-rays is diagnosis. It is possible that part of the reason for Medicare’s lack of reimbursement for examination and x-rays is that some chiropractors claim that they do not diagnose.

The Federal Employees Claim Act (FECA) for workers’ compensation has similar language limiting coverage to “correcting a subluxation demonstrable by x-ray”. It also requires an explanation concerning how the subluxation is the result of the work injury. FECA only pays for chiropractic manipulative therapy to correct spinal subluxation.

Many other ERISA insurance plans, such as the Blue Cross Blue Shield Empire plan for the Marriott Corp., are adopting a similar limited, “straight” chiropractic definition. They only pay for chiropractic manipulation. Many of these ERISA plans will choose the most limited definition of chiropractic.

A professional definition of chiropractic has a direct influence on the integration, utilization and economic reimbursement for chiropractic services.

For doctors of chiropractic, integration into the healthcare system means more patient access, more secure employment, more employment mobility, more economic rewards and better access to research and education opportunities. Isolation means the opposite.

• The drugless and non-surgical practice of chiropractic.

Differences among us

Despite the common ground we share in chiropractic, differences exist. We have two main groups who differ in philosophy and practice — the “mixers” and the “straights.”

The current disunity in the profession can be traced back to D.D. and B.J. Palmer. D.D. Palmer proposed a holistic type of approach to good health by emphasizing the manual adjustment of spinal subluxations to decrease nerve interference in combination with patient’s adjustments to decrease toxins and negative autosuggestions. However, B. J. Palmer departed from the founder’s holistic approach. He radicalized the profession by advocating his ideas on the chiropractic subluxation as the paramount cause of disease and the vertebral adjustment, particularly that of the atlas-axis joint, as the main treatment. These hypothetical ideas are chiropractic philosophy.

The mixers and straights today each profess their own ideas and practices:

• Mixers. This group advocates a holistic approach to health, balancing multiple factors such as spinal health, physical fitness and nutrition to avoid disease.

Mixers use a variety of natural and mechanical methods, including chiropractic adjustments, physical therapy, acupuncture, nutrition supplements, exercise and meditation to aid the body’s healing process.

This group utilizes medical diagnosis methods including blood work and other diagnostics. They tend to accept scientific methodology for the validation of clinical practice. As chiropractic physicians, they work with, and want to be a part of, the larger established medical system.

• Straights. This group advocates the chiropractic vertebral subluxation — segmental dysfunction — as a paramount cause of disease. It also limits the chiropractic practice to the correction of vertebral subluxations by manual adjustments in order to remove nerve interference and to let the body’s innate intelligence flow.

Straights prefer to use chiropractic analysis instead of medical diagnosis. They have historically preferred to use chiropractic philosophy as the basis for their clinical practice instead of scientific methodology. They are opposed to be regarded as chiropractic physicians and prefer to be called chiropractors.

They strongly advocate chiropractic to be a separate, distinct and different practice from the medical system.

The solution

I’d like to suggest that the things we have in common are like the roots and trunk of a strong professional tree. The roots and trunk supply the raw materials (common knowledge) while the branches (in this case, the mixers and straights) are supposed to provide the energy to keep the tree healthy.

The problem is that neither of the branches wants to be a branch. Each wants to be the tree. This controversy is weakening the profession and stunting its growth. Regardless of which branch chiropractors choose to belong to, they cannot kill the other branch to become the trunk.

In fact, the tree is strong enough to grow other branches. These branches represent different ways to apply professional knowledge.

The idea of a professional tree with branches is not new. Other professions have diffused the pressure of differing opinions about the nature of their profession by creating specialty branches. For example:

• Engineering. This profession has a common history and educational foundation, but engineers co-exist peacefully within their specialty branches — chemical, electrical, mechanical, civil, aerospace etc.

• Medicine and osteopathy. The medical and osteopathic professions, each also have a similar historical and educational background, not without controversy. They also co-exist peacefully within their many specialty branches — internal medicine, psychiatry, pathology, orthopedics, etc.

A new definition

Borrowing from the tree analogy, I propose the following simple and concise definitions for the chiropractic profession’s consideration:

Chiropractic is a system of healthcare that promotes optimal whole-person wellness, physical fitness and spinal health. Chiropractic physicians treat human ailments without the use of prescription drugs or incisive operative surgery.

Within chiropractic are two main branches: chiropractic spineology and chiropractic medicine:

• Chiropractic spineology is the branch of chiropractic that studies the effects on health of vertebral segmental dysfunctions in the human spine. These doctors of chiropractic optimize wellness and treat human ailments mainly by manual adjustments to dysfunctional vertebras on the spine.

• Chiropractic medicine is the branch of chiropractic that studies the combined effects on health of proper spinal function, physical fitness, mental/emotional fitness and nutrition. These doctors of chiropractic optimize wellness and treat human ailments with spinal manual adjustments, as well as with natural, mechanical and other common domain health care methods.

These two branches, chiropractic spineology and chiropractic medicine, should be recognized, accepted and formalized by the use of elective course-work and short post-graduate training and board certification. Only then will these camps of thought recognize themselves as branches and stop tearing apart this profession.

A board certification in one of these two branches would give the chiropractic profession needed credentialing in knowledge and methodologies that are highly relevant to their practice. Doctors of chiropractic should attain diplomate status by obtaining certification as either a diplomate in chiropractic spineology, DCS, or a diplomate in chiropractic medicine, DCM.

Membership to either branch should be a matter of study, dedication and choice. It should not be a matter of opinion, dogma and ideological fascism.

Kent Greenawalt, CEO of Foot Levelers Inc., recently launched an effort to unite chiropractic leaders in sending a single public relations message. Crucial to this effort is creating the best possible definition of chiropractic, combined with an attractive health message that is well understood and well liked by the general public and healthcare administrators. The definition must be expressed in correct modern terminology and allow for the existence of both professional groups, straights and mixers.

The suggested definition meets this criteria. Let’s move forward.

Dr. Robert Jusino practices in River Forest, Ill. He can be contacted at Jusino@comcast.net or 708-771-0665.

Editor’s note: To read Dr. Jusino’s unabridged essay, go to our Special Anniversary Web page, www.ChiroEco.com/50 and click on Bonus Articles!

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