Thank you for the opportunity to respond to the news release from Western States Chiropractic College regarding the development of a doctor of chiropractic medicine curriculum and degree.1
The curricular development outlined by President Dr. William Dallas, according to the news release, is designed to "broaden the scope of practice to better serve the needs of patients." Later in the news release, another motivation for the program is provided "with the goal of national health reform ... chiropractic as currently practiced could be eliminated or severely limited in the evolving system if it is unable to provide full primary care." The concerns of the parties involved in this effort appear reasonable, but upon closer scrutiny they represent vacuous arguments.
The entire concept of this degree offering is based on the misguided notion that there exists one central agreed upon definition of primary care and further that chiropractic as practiced today on the primary contact, portal of entry basis is not embraced with the definition. Finally, the argument assumed that the discussion of national health care reform has concluded with a minimized role for the doctor of chiropractic.
Primary Care
Numerous articles have addressed the subject of primary care. Approaches have ranged from defining the issue in terms of the specific care rendered to defining the issues in terms of the response to needs of the patient. Consensus does exist relative to the triage role that a primary care provider should offer. The issue here is knowing what a patient needs, providing that care or directing the patient to the required care.
Many of us within the chiropractic profession are of the opinion that we have always provided primary care and further that we have done so effectively and efficiently. The view may be inconsistent with the nearly 20 year old position of the Institute of Medicine (IOM)2 concerning primary care allopathic physicians, but is remarkably consistent with the opinions of this decade offered by Starfield3 or Gonyea4 regarding primary care providers.
The very definition of primary care cited by WSCC ("'Primary health care' means holistic health care which the client receives at the first point of contact with the health care system and which is continuous and comprehensive") fails to offer one word or a single concept that is inconsistent with the current manner in which chiropractic is practiced the world over. The Oregon regulation needs no adaptation to encompass the role of the chiropractor and the concepts of chiropractic as currently practiced need no adaptation to fulfill the expectations of the cited regulation. The inclusion of pharmaceuticals is not an integral part of the definition of primary care, and using the same is an excuse designed to rationalize a movement into medicine.
"To better serve the needs of the patients"
Dr. Dallas has put the concept of the doctor of chiropractic medicine forward as a means of better serving patients. This assumes the public would be better served by chiropractors incorporating, among other things, the use of pharmaceuticals in their practices. A review of current literature indicates that the use of many such pharmaceuticals has resulted in a near catastrophic, apocalyptic circumstance for our world through the rapidly accelerated evolution of resistant strains of pathogens of all varieties.5,6,7,8 Further review offers evidence of great morbidity and mortality from prescription drug use. In the United States, the use of anti-arthritic preparations alone results in more deaths than from all the illegal, illicit drug usage in our country.9 Leading authors have indicated that up to 36 percent of people under medical care are being treated for an iatrogenic condition or disease.10
The public would not be better served through more providers applying products that are readily available elsewhere and abandoning the conservative, nontoxic, minimally iatrogenic care that chiropractors provide. In fact there would be a considerable disservice to the public through the diminution of alternative to medical care and increased confusion as to the care the public may receive from a given provider.
Curricular Hubris
A one year postdoctor of chiropractic curriculum is being proposed that will result in:
"... a chiropractor fully trained to deliver primary care."1 "... a physician equipped to provided a full range of both primary and chiropractic care."1 "... clinical training characteristic of definitive, comprehensive primary care."1
The curricular design would offer one year to address the range of pharmaceuticals to be "fully trained," to provide a "full range" or to offer "definitive, comprehensive primary care." One year to master the surgical competencies one would expect of a fully trained person offering a full range of definitive comprehensive primary care. This would represent the epitome of curricular, clinical, and training efficiency. It is remarkable that medicine requires a medical school education with extensive pharmacology training, and three years of postgraduate education to yield a fully trained provider offering a full range of definitive primary care!11
Political Naivete
If one were to assume that the above curricular and competency goals could be obtained in this year of training, and that such goals would be desirable, who has any indication whatsoever that its application in a clinical setting would be acceptable any place in the world -- including even Oregon? One needs only a cursory review of the history of osteopathy to appreciate that what is being proposed is professional, political, and social folly.12
Issues of licensure, accreditation, and malpractice are the first steps in the discussion, and contrary to the expectations of Western States, are formidable and appropriate barriers to this ill conceived concept. In the accreditation arena, for example, the CCE's very recognition as a reputable agency by the Department of Education is based upon the DC degree13 and does not offer the latitude to embrace a DCM. The number of changes that would be required to be made by a two thirds majority vote of the CCE are sizable.
The Bottom Line
All of the rhetoric and posturing aside, the response of Western States represents a fear-ladened reaction to discussions of national health reform. Decisions are being made and the future of the chiropractic profession is being altered in an irresponsible fashion just as we are about to see our clinical approach and profession come into its greatest hour. A response such as that offered by Western States represents an apologist's view of chiropractic. It is a view that says chiropractic is not valuable to the public, a view that says conservative, drug free, nonsurgical care is of little value in our society and cannot exist on its own merit.
Clearly we are in the middle of a period of attack.14 A one trillion dollar industry is being reshaped and our enemies are taking their best shot to knock us out of the picture -- and they would be doing so even if we did prescribe pharmaceuticals. This isn't rocket science, it is predictable, expected, and well-understood. Protection of professional interests, not the needs of the public, are at the top of the political agenda of organized medicine.
The profession Western States seeks to create has already been created. It is called osteopathy. Practitioners of medicine and practitioners of chiropractic should be insulted with such schizophrenic meanderings. If there is a wish to advance a medical curriculum do so. Accreditation should be sought from the American Osteopathic Association or the Council on Medical Education, and licensure should be sought from the appropriate medical board. If there is a wish to develop a new profession do so, but don't destroy what the chiropractic profession has worked for 100 years to build.
Some years ago, many in chiropractic were concerned that our ultra straight colleagues sought to define a new profession under the rubric of "straight chiropractic." Today, Western States has completed the circle with the discussion of "chiropractic medicine." This latest effort is incredibly harmful to the public and to the profession and should not be countenanced.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
