The National Institutes of Health (NIH's) Office of Alternative Medicine has designated chiropractors as manual therapists, along with massage therapists. As pointed out in my prior articles, some of our leaders are reticent to claim a leadership role in the alternative care field because they believe we will be laughed out of the court of public opinion.
The leaders of the World Federation of Chiropractic (WFC) at their conference in Tokyo went so far as to seek to vote themselves "mainstream medicine." They equated this with being scientific.
Dr. Anthony Rosner, director of research for the Foundation for Chiropractic Education and Research (FCER), convinced the WFC to table the resolution. Dr. Rosner has demonstrated that alternative medicine is basically defined as all medical theory and practice other than that espoused by the politically powerful, organized, allopathic community. We cannot simply vote ourselves into the mainstream. (See Dr. Rosner's article in the August 11, 1997 issue of DC.)
The medical establishment has grabbed power over alternative medicine to some extent part by dividing up the field into seven subcategories so that there will not be any united voice in opposition. I'll discuss those categories and correlate them with what chiropractors are doing in their practices (according to the figures from the Job Analysis of Chiropractic, National Board of Chiropractic Examiners, 1993).
The second prong of organized medicine's attack on chiropractic (especially such "quackbusters" as William Jarvis) is philosophical (metaphysics). As I have attempted to suggest previously, this is not just an issue between allopaths and chiropractors, but goes to the very heart of Western society. I will return to this issue in my next article.
Obviously, one cannot resolve the mainstream versus alternative issue without looking at the chiropractic legal scope of practice. In the United States, this is a matter of state law. I will look at lessons to be learned from California legal history in a subsequent article.
Excluding possibly massage therapists, psychologists and persons licensed under dual licensing such as homeopaths in Arizona, there are basically five categories of health care practitioners licensed to deal directly with the public. The numbers designate the licensees who participated in the preparation of the NIH report.
| Chiropractors | 2 |
| Acupuncturists | 9 |
| Naturopaths | 11 |
| Allopaths | 20 |
| Osteopaths | 2 |
| Total | 44 |
There were 195 persons who participated in the preparation of the NIH report, including dance therapists, music therapists, "healing hands" therapists, and non-licensed persons (shamans and Indian herbal medicine practitioners, etc.).
The NIH report indicates that there are 6,500 acupuncturists/chinese medicine practitioners, and 1,000 naturopaths in the United States. These figures, when compared to the numbers developed by the NBCE, show that the true profile of chiropractors has been ignored by the NIH. We cannot afford to let this continue.
The NBCE survey refers to percentages of chiropractors doing certain things. I will, in the statistical references in the next section, convert the percentages to raw numbers, based on an assumption that there are 50,000 chiropractors in the United States.
Should chiropractors be asserting more of a leadership role in the development of the alternative care field? Clearly we should, based on the numbers previously cited and those developed below. Of course, there is more to it than just the numbers.
What is Alternative Medicine per the NIH?
Mind-Body Interventions: This category obviously places the metaphysical questions introduced in my "Dissent 2" article squarely on the table. I introduced those questions by essentially discussing the issue, "What is mind? Let's look at a couple of examples cited by the NIH as being part of mind-body medicine.
Hypnosis and Biofeedback: The NIH study (p. 20) traces hypnosis and magnetic healing (Franz Mesmer) back to the 1800s. DD Palmer, of course, started his healing career as a magnetic healer. The NBCE survey (p. 78) indicates 9.6% of chiropractors in the U.S. use biofeedback (4,800 DCs ). Not bad for a start in claiming our rights within this territory.
Bioelectromagnetic Applications in Medicine: This involves all kinds of electrical modalities, but particularly the "nonionizing portion of the EM spectrum, particularly at low levels" (e.g., electroacupuncture, NIH study, pp. 48-50). Although the NBCE survey does not indicate how many chiropractors are actually doing electroacupuncture, it indicates that 33,000 (65.6%) use "acupressure/meridian therapy," and 6,000 use needles.
I have had the privilege of taking Dr. Amaro's acupuncture course. When you recall that there are only approximately 6,500 separately licensed acupuncturists in this county our prerogatives in this area are clear.
Alternative Systems of Medical Practice: The NIH study lists the following "systems":
This is a disservice to Dr. Goodhart et al. Healing hands is a therapeutic technique, not diagnostic per se.
The NIH study indicates there are 50,000 biofield practitioners in the United States, and that they administer 18 million sessions annually. Perhaps chiropractors got included in the numerical calculations in this instance. Otherwise, I suspect somebody is pulling somebody's leg.
Pharmocolgical and Biological Treatments: According to the NIH, this category deals with an assortment of "drugs and vaccines not yet accepted by mainstream medicine." At first blush this seems outside our arena, but consider three of their cited examples: 1) chelation with EDTA (an amino acid); 2) the medicinal use of various products from the common honeybee; and 3) "neural therapy."
Ignoring any issues related to the use of hypodermic needles, chelation and the use of honeybee products falls within the scope of naturopathic practice (see my "Dissent 4").
Neural therapy utilizes anesthetic injections to produce a variety of therapeutic effects, and is based upon the principle that "all neural-therapeutic methods either supply energy to damaged tissues or remove energy blockages."1 The author of this quotation goes on to compare neural therapy with, among other things, what he (as a German) terms "chirotherapy."
Personally, I am not in favor of chiropractors using drugs, but saline injections and dry needling for trigger points is a form of neural therapy. Could such applications be extended?
Herbal Medicine: Suffice it to say that until at least 1948 the curriculum at LACC included herbology, and phytology (also "hormones" and "glandulars." What about the honeybee?)
Diet and nutrition: Obviously, not much needs be said about this category. The NBCE survey shows that 83.5% of us are involved with "nutritional counseling." It should be noted, however, that the NIH recognizes this field as including both prevention ("wellness") and treatment, which it then refers to as "orthomolecular medicine."
The various therapeutic practices of chiropractors in the U.S. touch and concern each of the categories of care into which the NIH has divided the alternative care field. Therefore, we have the historical, conceptual and moral right to claim leadership of the alternative care field.
But what about those such as the Association of Chiropractic Colleges and the WFC who believe we should carve out a limited niche for ourselves? What legal hurdles do we face with respect to capturing an expanded role in the alternative care market? I will address both of these issues in subsequent articles. In addition, I will address the issue of our mutual rights to seek different market identities.
Reference
1. Dosch P. An Introduction to Neural Therapy using Local Anaesthetics, Haug Publishers, West Germany, 1974.
David Prescott, DC, MA, JD, FIACA
Silverado, California
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