Should We Teach MDs Adjusting Techniques?

While the interdiction of teaching lay persons adjusting techniques is unquestionably justified, instructing MDs in chiropractic is in some quarters a more ambiguous matter. But a recent letter from Ingrid E. White, DC, vice president of the German Chiropractors' Association, makes a quite unambiguous argument against the reported actions of teaching MDs chiropractic by well known technique developer James Cox, DC, DACBR.

May 10, 1996

The Editor
Dynamic Chiropractic
PO Box 6100
Huntington Beach, California 92615-6100

Dear Editor:

This is in response to the letter from Dr. Cox in the May 20, 1996 edition and the "Lighten Up" letter in the same edition.

First, I would like to respond to the "Lighten Up" letter. It may be easier to "lighten up" when you are in an established profession, i.e., a profession that is defined and, thus to a degree, protected by law. We don't have that privilege in Germany. We have as yet to be able to define ourselves as a profession, which has a logical and sound education, parameters of practice and identification.

Now to the tougher part -- the letter from Dr. Cox. It is true that in his case we shall not accuse him of teaching non-chiropractors in Germany. In fact, I'm grateful of his strong stand against such practices. I quote, "I do not advocate teaching Cox distraction manipulation to unlicensed lay people." I do hope he also means MDs and physiotherapists. "I view such actions of teaching chiropractic to lay people as unethical and unhealthy for the chiropractic profession." This is a strong stand and I hope Dr. Cox has managed to transfer his feelings toward this matter to the distributor of his tables in Switzerland.

At a Cox seminar I attended in the Netherlands, two German health practitioners and a German MD attended also, and Dr. Cox was not very interested when I informed him of the situation. The Netherlands Chiropractic Association was just as upset as I was, but they had been sent the reservations by the Swiss distributor of Cox and Zenith tables.

In a more recent (1994) Cox seminar in Schaffhausen, Switzerland, at least six non-chiropractors attended. We have the names of three MDs, one health practitioner, one physiotherapist, all from Germany; and one Italian physiotherapist. I have the written statement of a German DC and the oral statement of a Greek DC on that matter.

I do not know whether Dr. Cox is aware of his distributors' ideas, that if you sell chiropractic tables to non-chiropractors you then have to teach them chiropractic technique so that they are able to use their purchases. But since Dr. Cox teaches courses under auspices of the National College of Chiropractic, I think he should be interested in who takes his "how to" courses. I am sure glad of his strong convictions in that matter and I hope he extends them to the new "Berlin School of Chiropractic," which sells Cox tables, and also Activators, Thompson tables, and Toftness instruments. The "Berlin School of Chiropractic" is another example of one U.S.-trained DC, a D. Ranchod, formerly of Seattle, Washington, selling chiropractic technique to interested lay people willing to pay for weekend courses and "receive the same fine training as a DC in the U.S.A."

To the Busch, Campbell, Abgrab (May 8, 1996, "Ugly American DCs") type of "colleagues" I can only say they should not make our decisions and try to tell us how to handle our professional situation unless they are willing to live and work here. To my knowledge none of them have ever contacted our association. I consider their comments very arrogant.

Chiropractic has a long tradition in Germany. One of these days we shall write our history of all the hucksters, and also some well-meaning people, who have managed to lead us further and further away from a separated identity as a chiropractic profession because they have sold our techniques to pre-existing entities (MDs and health practitioners).

Yours sincerely,

Ingrid E. White, DC
Vice President
German Chiropractors' Association

"DC" faxed Dr. White's letter to Dr. Cox for comment. Dr. Cox replied:

June 17, 1996
The Editor
Don Petersen, Dynamic Chiropractic
PO Box 6100
Huntington Beach, CA 92615-6100

Dear Dr. White/Mr. Petersen:

In response to Ingrid White, DC, vice president, German Chiropractors' Association, stating she hopes my not advocating lecturing to unlicensed lay people also means MDs, and physiotherapist, I state this is impossible, and not desirable. To my knowledge, I have never taught the performance of chiropractic technique to anyone other than first professional degree doctors or students, in the U.S. or anywhere else. So far as non-chiropractors practicing manipulation in the United States, Germany or anywhere else in the world, I have no control over this. It is a legal status. If the law allows medical doctors to practice manipulation, no one can stop them. I may not like non-chiropractors manipulating or adjusting the spine, but if the law allows it they can do it. I do demonstrate chiropractic technic in lecture to groups with chiropractors, medical doctors and osteopaths, and even physical therapists in the audience. If they practice manipulation from what they see, or even study from textbooks, the only way to stop them is by making it illegal.

In my career, I have spoken before the American Back Society, Challenge of the Lumbar Spine, and other such symposiums attended by medical doctors, chiropractors, osteopaths, and physical therapists. At these conferences, academics is discussed on the diagnosis and treatment of low back pain to include demonstration of technic. There is no way to isolate knowledge of the epidemic problem of low back pain. It is common to see chiropractic physicians lecture to other health care providers on their special contribution to treating low back pain, including Dynamic Chiropractic, June 17, 1996, 14(3), page 19, "FCER and Chiropractic Go to Harvard." In this article, two FCER board members held a parallel workshop that introduced participants, including 40 medical doctors, to the actual practice of chiropractic. I will continue to lecture, covering the mechanism, diagnosis, and application of chiropractic technique, with any group of first professional degree health care providers as I have in the past. It is only through interdisciplinary study and interaction that the best patient care will evolve.

I feel our profession needs to study and share knowledge with other branches of the healing arts, whether it be the United States, Germany or any other country. In no way is my name connected with any of those persons you accuse of teaching lay people a weekend course of spinal adjusting (Busch, Campbell, Ranchod, Abgrab).

Any lecture I have ever given in Europe has been at the invitation of a national chiropractic association, for example, for the Netherlands Chiropractic Association, or at a medical hospital in Schaffhausen, Switzerland, where I knew of no lay people attending, only doctors with healing arts degrees, chiropractic, medical, or osteopathic. Attendees at these conferences are not selected or screened by me, but by the sponsoring organization.

I will help in any way to attain licensing for chiropractic in any country, and I think that this is the attitude of all of organized chiropractic. I do not feel that refusing to share knowledge with other branches of the healing arts community as the leader in spinal care by research and constantly improving clinical results.

Respectfully submitted,

James M. Cox, DC, DACBR Diplomate, American Chiropractic Board of Radiology

While Dr. Cox seems to suggest that it is standard academic practice to teach adjusting techniques, researcher John Triano, MA, DC, doesn't agree. In Dr. Triano's article on the front page of this issue, "Teaching MDs How to Refer to DCs," he asserts a belief in teaching about chiropractic, but not how to perform adjustive techniques:

"While the license to practice medicine is unlimited, the privilege to practice a certain procedure is just that. It is a privilege in which the doctor must prove competency. A doctor will not be credentialed to perform certain procedures until they can demonstrate competency. It is not a simple matter of scope of license. Those who teach MDs to manipulate provide documentation of competency that may not exist and empower them to perform procedures they may not otherwise be able to perform."

Dr. Triano's position is also supported by a recent resolution unanimously passed by every licensing board in the United States at the April 20, 1996 annual meeting of the Federation of Chiropractic Licensing Boards:

"Opposing weekend teaching of chiropractic to non-chiropractors, and urging boards to act within their available laws and regulations to sanction their licensees who participate in such programs.

WHEREAS, the Federation of Chiropractic Licensing Boards is dedicated to supporting the regulatory boards' mission of protecting the public's health, safety and welfare; and

WHEREAS, the patient public can be endangered by the practice of chiropractic by persons with inadequate education and training; and

WHEREAS, minimum educational requirements for the practice of chiropractic have been outlined by both jurisdictional law and federally recognized accrediting agencies; and

WHEREAS, those requirements appear to have been violated by certain entrepreneurial programs which purport to teach chiropractic to non-chiropractors in a limited program of a few weekends; and

WHEREAS, such conduct falls outside professional ethics and may also be grounds for disciplinary action in certain cases; now therefore be it

RESOLVED,

That the Federation officially opposes such programs and urges its member boards pursue whatever legal remedies they may have within their jurisdictions to sanction their licensed chiropractors who participate in these programs.

John Sweaney, DC, president of the World Federation of Chiropractic (WFC) had some thoughts on the matter:

"The WFC has three problems with Dr. Cox's attitude that it is legitimate for him to teach chiropractic technique to MDs and other health professionals in European countries.

"Firstly, chiropractors should not teach isolated technique seminars to MDs and other professionals who intend to practice these techniques. This encourages unsatisfactory and unsafe practice. The WFC strongly supports the position of the FCLB and Dr. Triano.

"Secondly, no chiropractor should do this in a foreign country. This is a violation of WFC policy -- policy supported by all national associations worldwide, including both the ACA and ICA. It has the potential of destroying the chiropractic profession in a country such a Germany.

"Thirdly, a chiropractor with commercial interests should be particularly cautious. The WFC is informed by the German Chiropractors Association that a European agent for Cox tables has registered non-chiropractors as chiropractors at one or more European seminars addressed by Dr. Cox. What Dr. Cox knew I cannot say, but the motivation for this seems clear. The WFC understands the anger of the German chiropractors, who live in a country where these non-chiropractors can and do say that they are now practicing chiropractic.

"For these reasons the WFC has a policy of seeking sanctions against those who disregard its policies and the interests of WFC member associations."

While the issue of teaching MDs chiropractic techniques appears to be more of an "academic" question in the US, Canada, and other countries where chiropractic is well established, it may not be for most of the world. And while interdisciplinary discussion of the value of chiropractic is almost always beneficial, many believe that the teaching of chiropractic techniques to medical doctors is nothing short of heresy.

Teaching MDs chiropractic is not against the law. The consensus of the chiropractic profession on this matter (see "Report of My Findings" on page 3) will perhaps guide those individuals involved in such teaching whether or not to continue the practice.