Dr. Katz: The Orthopractic Society was started by a group of people, about three or four people within the pediatric community in Canada, as well as physiatrists, two physical therapists, and a chiropractor who spontaneously after many years of communicating with each other came up with a solution which they thought would be suitable to everybody. It was a reflection of the great concern within the pediatric community to try to find some way of resolving what we consider to be dangerous in terms of chiropractic involvement with children. It was a concern with the chiropractor involved to try to provide a way for chiropractors who wanted to limit themselves to scientific use of manipulation therapy to have a way of doing that. It was a way for the medical people involved, other people involved within the medical establishment, to say that we can accept chiropractors who function in this way. So the society arose spontaneously through a discussion group which eventually grew to 23 people, and eventually formulated the name orthopractic, and the written guidelines.
There are many chiropractors involved in that formulation: physical therapists were involved, osteopaths, orthopedic specialists, and it took almost two years of consultation and sharing of opinions. The National Association of Chiropractic Medicine was not involved at the beginning and did not get involved until the process was about three quarters of the way through. It is also the policy of the group not to have any official association with any established group such as the American Medical Association, or the Canadian Medical Association, or the American Chiropractic Association, or the Canadian Chiropractic Association. Our concern was simply scientific: to study the available information and to work out a way where everyone -- chiropractors, physical therapists, pediatricians, doctors -- could work together. Part of the process involved people who were in government and were concerned about what government was paying chiropractors for, part involved insurance companies who were concerned about the same thing, and everyone eventually came together as a group, which grew to be close to 30 people, and finally the document was produced, and the association was formed.
My function is as a member of the editorial board of the pediatric section. I have been very prominent because pediatrics has been a big concern of the group, and because also the attack of the chiropractors has been against me on a personal basis. But in fact, there are I think, much more significant people other than myself involved behind the scenes doing a great deal of work, and I hope my own personal involvement will not be too much longer in the future curtailed because I have many other interested.
"DC": How many members does the Orthopractic Manipulation Society have?
Dr. Katz: In terms of registered members now, we're close to 1,000. I would say we're about seven or eight hundred at this point in time, but we have the potential for many, many more members. We have been officially endorsed by the McKenzie Institute International, which has over 20,000 members. We're endorsed by the Back Institute, which has many members. But we're not concerned about the numbers that much, we're concerned about what the scientific evidence is. We don't really care how big we are -- we estimate that we will grow to two or three thousand members within probably a year or two. But that's not our concern. Our concern really is to give a way for those chiropractors who wish to practice safe, scientific manipulation, a way to do so, and get positive recognition from the medical establishment. I think that I personally have done more for those types of chiropractors getting acceptance within the medical profession, as I am very much involved in the medical establishment being a teacher and being very involved in lots of works, some committees and stuff like that within the medical establishment. By medical establishment I mean sort of a upper scientific medical community.
I think I've done more for chiropractors who want to practice in a safe and scientific way and be recognized than probably any other doctor, because I've gone to my colleagues in the medical licensing boards and in the associations and different groups and said, "If there are chiropractors who want to reach out to us, we have to reach back to them, and we cannot just call everybody 'quacks' and be negative. We have to be positive, we have to sympathize with those who want to change, we have to give them a way to be identified, to get out if they want to, and that way is to use the suffix orthopractic after their name." I am constantly convincing my medical colleagues -- pediatricians, orthopedic specialists, people in licensing boards, people who have influence within the medical community -- to reach out to chiropractors and to welcome them into the scientific community.
"DC": Why are you working with the National Association of Chiropractic Medicine?
Dr. Katz: The National Association of Chiropractic Medicine wanted to become with the Orthopractic Manipulation Society International. So they really applied as individual members to join the OMSI, and as OMSI expanded and was looking for people for its editorial board, some of the members of the NACM have joined. But not all the chiropractors who are on our boards working with us are only NACM members. It really depends on scientific background, qualifications, training, a whole bunch of things like that. We have a lot of sympathy with the chiropractors we've met from the NACM because we find that they seem to be the easiest group to accept what we consider to be the truth about what manipulation can and cannot be used for.
"DC": Are you aware that the executive director of the NACM, Dr. Ron Slaughter is known to have worked with organizations that have tried to destroy the chiropractic profession?
Dr. Katz: I don't believe that. I don't think that Ron or myself, or anybody else, is out to destroy the chiropractic profession. I believe that there are two professions out there: There is a profession which believes that manipulation of the spine can be used to treat things other than musculoskeletal complaints, and there's a profession out there which doesn't believe that. Just as I have a right to limit myself to pediatrics and by doing so I don't destroy the medical profession, I don't see why chiropractors should object to someone wishing to limit themselves to musculoskeletal care only.
I think the concern of Ron, the concern of the medical community, and the concern of medical science, and of many, many people in government and insurance companies and so on, is to see that medicine, including manipulation therapy, is practiced in a limited, safe, scientific way. I think chiropractors who practice it to treat all types of things will always exist. We have the finest hospitals to treat cancer, but people still want to take megavitamins to treat cancer. We're not going to get rid of that. I think if people want to see a chiropractor and they feel that it is helping somebody for whatever is bothering them, I can't stop that and I don't care to stop that. What I object to is the fact that the schools which graduate chiropractors who believe in chiropractic philosophy, these graduates are allowed to call themselves doctors, they're allowed to use x-rays, they're allowed to prescribe their own brand of medication, they're allowed to be publicly funded. If a chiropractor wants to claim to cure a kid's earache by manipulation, that's his right and I don't really think I'm going to stop that. But if I am going to pay for it out of my tax dollars, then I think there is an issue there. If someone would graduate from an orthopractic school, I think they should have those rights, not from a chiropractic school.
"DC": Were you aware that Dr. Slaughter in his own curriculum vitae, page 2, states that he acted as a consultant for "Mr. Doug Carlson, JD, counsel for the American Medical Association, regarding the Wilk trial"; "Mr. James Cerney, JD, counsel for the American Radiology Society, regarding the Wilk trial"; "Dr. William Jarvis, PhD, president of the National Counsel Against Health Fraud, and Dr. John Renner, MD, chief medical advisor to the president of the Senate Investigative Committee on Health Fraud"?
Dr. Katz: Sure, I know that Dr. Slaughter was asked by those people, and I think the issue really is, these types of personal attacks or innuendo about what people do -- really there's only one issue here and the only issue is: Do subluxations exist in any way to effect our health? Chiropractic is based on three theories, really: that joint dysfunctions exist from birth on in just about everybody, that these effect our total health, and that these can be adjusted and fixed. This is a theory which will never be shown to be true because the body just does not work that way. You cannot redirect nerves, you cannot redirect the way the body is built. You will never produce a study showing that otitis media is caused by a pinched nerve because the glossopharyngeal nerve doesn't go there. So we can talk about, as people have talked about, me and what New Zealand said, or about what Ron did -- the trouble with chiropractic and the reason it really hasn't changed in a hundred years is because it acceptance is not going to be based on challenges to the AMA, winning Wilk trial legal cases, suing people, having massive publicity campaigns launched in reaction to "20/20" or the Wall Street Journal or Consumer Reports and there's more coming up, it's going to be changed by chiropractors accepting that musculoskeletal care has a limited and a valuable role to play. And all of the acceptance which appears to be out there, in terms of chiropractors and doctors working together, is based on doctors believing that those chiropractors treat only musculoskeletal care.
Now that the medical doctors and the community have a way of distinguishing those chiropractors who treat only musculoskeletal conditions, and don't claim to treat colic or bedwetting, I believe we are going to see a massive shift away from general chiropractors who claim to treat everything in terms of medical referrals, medical cooperations -- medical cooperation with them -- to those chiropractors who identify themselves as orthopractic. We see that going on now with hundreds of requests that we've received from doctors and radiologists and people in the medical community saying, "Can you give me the name of someone who's orthopractic?"
Chiropractic has gotten stuck in treating five or six percent of the population. Becoming orthopractic affords chiropractors the opportunity to move into the mainstream of medical science, expand the number of people they'll be treating, work cooperatively and scientifically with a group of doctors, and I am proud and happy to help any chiropractor who wants to do that -- to reach out, to reach back to them.
"DC": Much of your internal communication suggests that you have testified before President Clinton's health care reform panel against the inclusion of chiropractors as primary contact providers. Is this accurate and would you comment?
Dr. Katz: There are some things I am doing which I consider still confidential. I will tell you that the chiropractic profession, the American Chiropractic Association, has spent a lot of money trying to get coverage under the U.S. administration. I believe that whatever acceptance they do get will be under orthopractic limits and not general chiropractic. That is the impression that I have, and I can't comment specifically on the people who have contacted me and the people I'm meeting with, but I can say that in the long run I really am 95 percent convinced that chiropractic inclusion will be under orthopractic limits. Whether that will be right at the beginning, because there is a battle between the politicians and the civil servants, whether that will be a year down the road or two years down the road, I can't see it coming out any other way. There are just too many people within government, within the insurance industry, within HMOs and so on, who are saying very clearly, "What are the orthopractic guidelines, how can we work only with chiropractors or physical therapists who conform to those guidelines?"
"DC": Does your organization regard physical therapists and chiropractors as equals?
Dr. Katz: No. They are equal if they join in terms of their skills. In terms of manipulation therapy, we expect physical therapists to have some additional training. There are two institutions which are set up now for physical therapists to achieve those skills, and we also expect somewhere down the road that either a chiropractic school might become orthopractic or there's a movement afoot now, because there's a committee of the Orthopractic Society dealing with education, to create special postgraduate courses either through the McKenzie Institute International or through, there's two or three other groups involved whereby a chiropractor or physical therapist would receive some additional recognition. Right now we accept them as equal, but after the founding convention of the Society, which will take place at the end of September, there will be standards set for future acceptance. But at the present time, I would say that the average chiropractor has had more training in manual and manipulation therapy than the average physical therapist.
"DC": In terms of referral, do you refer members of the public to physical therapists and chiropractors equally?
Dr. Katz: Yes, absolutely. It is the policy of the OMSI to refer when someone asks for a referral to somebody, and since Consumer Reports has come out we've received literally hundreds of requests from individual people. It is our policy to refer all members that we have on our list, be it medical doctor, orthopedic specialist, osteopath, chiropractor, or physical therapist on an equal basis.
"DC": Do you require those physical therapists to have some kind of formal postgraduate qualifications in manual therapy?
Dr. Katz: We ask that they have either what's called comp. training in Canada or that they have some training from the Institute of Physical Therapy in the States which deals with manipulation care. We haven't been strict about that requirement just yet, but it's becoming stricter, and in fact I would say that 99 percent of our members do have that type of extra training.
"DC": Since the training by your own admission is not comparable, how can you conscientiously refer the patients to PTs who may have learned manipulation at a weekend seminar with no real foundational training?
Dr. Katz: When someone goes for a back treatment to a physical therapist, we're not only referring them for manipulation therapy. We are referring them to learn how to take care of themselves rather than have someone else take care of them. We're referring them to have exercises explained to them, such as the McKenzie approach. We're referring them when necessary for manual therapy. There are many problems with chiropractic teaching of manipulation therapy as well, which tips the balance in the other direction. The orthopractic guidelines say that you don't need to take x-rays to see subluxations -- chiropractors are taught that. We don't think that is scientifically valid. Chiropractors are taught to treat children by manipulation therapy -- babies, infants, and so on -- physical therapists are not taught that. Chiropractors are given often an anti-immunization bias, which physical therapists are not taught. Chiropractors are taught that they can influence diseases such as asthma, heart disease, high blood pressure and so one, which physical therapists are not taught. So if you look at the total use of manipulation therapy, the physical therapist has many scientific positives, which the average chiropractor does not have. When you look at skill in terms of a technique, chiropractors tend to be better than physical therapists. When you put both things together, it is sometimes hard to choose between the two as to which one is overall better.
"DC": What was your role in the recent Consumer Reports article on chiropractic?
Dr. Katz: I asked Consumer Reports if I could share some information with them. They agreed that I could share some information with them. I shared that information with them. I found them very critical, very questioning, very concerned. About a month or two months before the article came out, I even wrote them a letter saying I think that it's going to be a good article from the way it seems to be heading. That was basically it. I had no role in writing it in any way whatsoever. I was not quoted in it in any way whatsoever, and there were many other people who contributed. I think they spoke with several hundred people, including many more chiropractors, than I did. But I expressed myself as to what I thought was important and what was not, and I think that the result where they only recommended the Orthopractic Manipulation Society International is very simple to understand. The Consumer Reports showed very clearly that chiropractic philosophical teaching is not true, there are no studies, and there never will be studies because that's just not the way the body works. Consumer Reports was looking for a group which would say, "We only do manipulation therapy for its safe, scientific treatment of low back pain." Our group was the only one, I think, that was willing to say so. I was pleased that we were recommended, and it was a bit of a surprise in the end that it turned out as well as it did because I found them very questioning and very critical along the way.
"DC": Betty Jane Anderson, special counsel for the Health Law division for the American Medical Association has stated that you claimed in April that you were "working with Consumer Reports on an article that was published in the June 1994 issue on chiropractic," and that you further stated that "the concept of orthopractic is to separate manipulation, a therapeutic modality, from the debate and attack chiropractic philosophy." This is also supported by different comments made verbally. Is attorney Anderson correct in her depiction of your activities?
Dr. Katz: I wrote her one letter, I guess it was maybe seven or eight months ago, I don't know the exact date and I don't have it in front of me, and if that's what I wrote in the letter then I wrote that. My working with Consumer Reports was trying to convince them to see what I would do. Subsequent to that, I never received any response, and I have never written to them again, because I don't think this is an issue that has anything to do with American or Canadian or any other medical associations. This has got to do only with what is scientifically true and what is not true.
"DC": In some of the initial communication, Dr. Slaughter claimed in print and in his interview with Dynamic Chiropractic, that "the AMA is in discussion with Dr. Katz at this time for the adoption of orthopractic. Is this true and who in the AMA are you working with?
Dr. Katz: No, absolutely not true. What was confusing that there were doctors who were members of the American Medical Association who were asking for information from us. Dr. Slaughter asked me at one point in time, "Are these doctors members of the American Medical Association?" I said, "Some of them are and some aren't." But there is absolutely no relationship whatsoever between the OMSI and the AMA, and it is forbidden in our frame of reference. If you look at the guidelines and how they are formed, it is specifically forbidden for us to have any type of organization -- We're not interested. We don't take a vote to decide whether pinched nerves cause otitis media. So there is absolutely no involvement of the organized medicine in any way in this whatsoever, and this has got nothing to do with trying to get rid of chiropractic. It's got to do with making safe, scientific manipulation therapy available, it's got to do with warning the public about chiropractors who claim to use manipulation to treat many diseases, and who take x-rays and are anti-immunization.
Just as I have personally warned the public in articles I've written about the dangers of (phelydomide)* when we go back 25 years, I've warned the public about high cost of medications, I've written articles against the medical profession for some of the price tactics that go on, which I think are not proper or some of the conflicts of interests with doctors owning lab companies where they've asked people to go get blood tests at. This is a very positive thing, it's not a conspiracy. It's a simple scientific issue. People have said to me, "You're trying to get rid of chiropractors and make sure that chiropractors only see patients on referral." This is not true, I am 100 percent in agreement with chiropractors who are orthopractic being portal of entry. I don't think that people have to see a doctor first. I don't think chiropractors are primary care physicians because to be a primary care physician means that you must have a treatment for everything, and if you believe that manipulation is a treatment for everything then you're not following scientific norms. But I think that a lot of chiropractors know a lot more about the musculoskeletal system than many, many doctors do, and I have absolutely no hesitation in seeing a patient who has musculoskeletal pain, and referring them to a chiropractor who sticks to the orthopractic guidelines. Personally, I would have no hesitation in having myself so treated by such a chiropractor.
"DC": Would you consider the letter that Dr. Slaughter sent out to many new members several months ago in which he stated that the AMA was in discussion with you for the adoption of orthopractic misleading?
Dr. Katz: Yes. Nobody does everything perfect all along, there's been lots of misleading enthusiams expressed. I think that my even writing a letter to the AMA at one point in time was an error. I was concerned about possible legal ramifications because I know chiropractors in the past have been very quick to sue and to attack, and I was probing for some information and then I realized that first, it wasn't necessary, and second, the Orthopractic Society subsequently said that we should not even contact any official associations. But I can tell you that there are many, many what I consider to be very influential and very important physicians in the United States, in Canada, and now in Europe and other countries of the world who are very, very supportive of the orthopractic idea. Some of these people do have a lot of influence within those organizations, but it's all on an individual basis.
"DC": You state in your patient guidelines that orthopractors and by reference chiropractors are, "self-limited specialists," and you do state in those same guidelines that any and all specialist treatment should be with the full knowledge and consent of your family physician. How does this work with your last statement, that suggested that chiropractors need not receive patients by referral?
Dr. Katz: I think that just as someone could go see a dentist directly, I think someone could go see a chiropractor directly. So whatever inconsistency appears to be there, it's not there in my way of thinking. I have absolutely no objection to someone who has a backache going to see a chiropractor directly. I think in 99 percent of instances, they've already seen their doctor anyway, and even if they're seeing the chiropractor there's nothing wrong with the chiropractor referring them back to the doctor if the chiropractor feels that is necessary.
"DC": But your patient guidelines here have many statements such as "As this is a limited scope of practice, it is recommended that you have a family doctor acting as a general health consultant who is aware of this treatment."
Dr. Katz: That is not in the orthopractic guidelines.
"DC": This is the Patient Guidelines for Spinal Manipulative Practice put out by the Orthopractic Society.
Dr. Katz: I didn't write that. The official guidelines of the Society specifically ... there's no mention of referral. Specific guidelines of the Society say that a person can go directly to a chiropractor.
"DC": Do the Orthopractic Manipulation Society International and Orthopractic Manipulation Society USA have the same guidelines?
Dr. Katz: Yes. The green pamphlet is the only official guideline. People can give little different interpretations to it if they like, but the official guidelines which are reviewed every two years are the green pamphlet, and that's the only official guidelines.
"DC": You may want to talk to Dr. Slaughter then, there's another set out, and I'm quoting from those right now.
Dr. Katz: I can just say that the only official guidelines are the green ones. Things have happened so fast and so dynamically that we have had trouble keeping up and responding to all the information. I think that after the national convention which will take place at the end of September, we hope people will communicate with each other more clearly. I've never met Ron Slaughter, we've never really met, we've never had the opportunity to sit down and talk. There's a lot of things that are not as perfect as they should be, but we're all extremely impressed with the rapidity with which this idea has been accepted, and extremely pleased by the large number of chiropractors. When you look over the CVs of these chiropractors we've (been) very impressed. We have some who are PhDs, and some who are MDs as well as chiropractors and we're just very, very impressed with the quality of people we have coming to us. I will do everything I can to make any chiropractor who wishes to limit their care to musculoskeletal conditions, welcome within the medical/scientific community, which is where the lion's share of care lies, and not in the six percent which wants to treat everything under the sun by manipulation therapy.
"DC": We understand that you are the incorporator of the Orthopractic Manipulation International. Is that true?
Dr. Katz: No. Technically, in order to register the name, it had to be incorporated. But the OMSI is a non profit group. It's set up as a non profit group, technically, in order to register the name internationally, we had to go through a private incorporation, but all of the functions of the OMSI are subject to the approval of the editorial board and to the constitution which is being developed. I might add that I am not a formal member of the constitutional committee, I'm an ***** member. The constitution of the OMSI will be developed by a group of about six individuals, including two chiropractors, of which I am not a member.
"DC": I have a copy of the incorporation documents from Canada, and they state that the organization has shares, which would make it a for-profit corporation and your signature is on it.
Dr. Katz: It's never issued shares. It has never issued shares. In order to be formed, the only reason it was incorporated was to register the trademark and to save it. That's why it was done that way, but it's never issued any shares.
"DC": But doesn't that make you the sole shareholder?
Dr. Katz: Technically, yes. But in order to do it, we had to ... it's really registering a trademark. At the same time that was done, the function of the Society was agreed to be a non-profit group with total responsibility to the decisions of the editorial board and the founding convention. So it's just a technical thing that in order to register a name and to safeguard that name, you have to incorporate the name. But if you did issue shares, if you did use those shares, it would be one thing, but in actual facts no shares have ever been issued and there are no plans to issue shares.
"DC": But doesn't that keep you in a position of total control, being the incorporator, the sole director, and the sole stock holder?
Dr. Katz: It gives me more control than other people, but in actual fact, if nobody belongs to the Society or it doesn't do anything, then it really is no control. I've made it very clear from the start that I hope within three to six months to not be involved anymore and to turn this over to other people. The only reason to me continuing to be involved would be if I felt there were pressing issues around the issue of children, which I felt were not resolved. In terms of creating a profession which will be called orthopractic and which will limit itself to musculoskeletal care, I'm not in that profession and I really don't feel that I have the right to decide what to do with it.
"DC": This seems a bit of a conflict because in a letter that Dr. Stanley Paris wrote he referred to you as "the entrepreneur behind the Society." Isn't he a member of your editorial board?
Dr. Katz: Yes, he is.
"DC": Is this an accurate statement?
Dr. Katz: Well, entrepreneur can be also termed as sort of one of the bright lights or one of the initiators. In actual fact, the genesis for the Society began more with the physical therapists and the physiatrists and another chiropractor, then myself. We all got together and I was asked would I be willing to come back into this issue and try to work on it in order to develop practitioners with safe, scientific manual therapy. I had a lot of hesitation because my experience dealing with this issue has not been a pleasant one. I've been subject to slander and to lies. I was subject to that with the New Zealand commission, you yourself wrote a personal letter attacking me to Consumer Reports, and I don't like lies and personal attacks -- it's not part of my makeup and it's not part of my need to function. I hesitated and in fact I did nothing for 10 years on this whole issue. I received requests for information which I never answered. I did nothing. I got back into it because a child who I felt was poorly treated by a chiropractor and at the request of others. I also got back into it because I became convinced from the work of Paul Shekelle and others that manipulation therapy did have a valuable role to play, and I think its an important role to play. I was very pleased to work within my medical community, and convinced my medical colleagues as best I could that there were chiropractors who were sincere, who were honest, who had a valuable therapy to offer that we should welcome into the mainstream of scientific medicine.
"DC": If all that you say is the case, how is it that when you incorporated and it asked for a list of directors and gave you lots of room to list them, the only director is yourself?
Dr. Katz: Because, as I say, we were registering a trademark, which we wanted to protect as early as possible. A lot of people were reluctant, as we set up a corporate structure -- we are not a corporation even though we registered as a corporation -- we would have to have contract agreements, we would have to issue shares, we would have to do a whole bunch of things, and we consulted with our lawyers and they said that if you are forced to incorporate and forced to have a director in order to protect a trademark which is the case, then that is what you have to do. Keep it as simple as possible, don't issue any shares, and have the real power of the running of the organization dependent upon an editorial board, which will then be dependent on the establishment of the constitution. That is exactly what happened.
"DC": And that is the case, even though in this incorporation application that you filed it says, "The corporation is authorized to issue an unlimited number of shares of one class."
Dr. Katz: That's right, but the corporation has never issued any shares, and it will not issue any shares. If you want to register a name and a trademark, you have to have a company. You have to have some type of registration, a person to do it, and that's just a legal requirement. It could have been done as an individual in one province in Quebec, but it could not be done on a national basis without a legal incorporation. To do so would have required individual registrations in each province, in each state in North America.
"DC": Are there any other directors of your corporation?
Dr. Katz: There is the editorial board.
"DC": Are they directors?
Dr. Katz: No one really is a director or not a director, including myself. As I say, this was really an issue of registering a name and that's the way legally it had to done. It's a non profit group and that's basically it.
"DC": I don't wish to argue with you, but you state that it's non profit and yet, this is a registration for a for profit corporation. There is a difference. And secondly, you say there are no directors, but legally, sitting on page three, is your name as the sole director.
Dr. Katz: As the sole person who registered it ...
"DC": No sir, that's an incorporator. This is down as a director.
Dr. Katz: But there are no shares. And there's no money too. It's really not a profitable enterprise, and I personally have spent thousands of dollars out of my own pocket as many other people have.
"DC": From your own numbers, you've listed 800 members, and assuming $75 membership fee and another $100 for the usual pamphlets, that comes up to $140,000 in your first year.
Dr. Katz: No, a lot of the registrations are in the U.S. Registrations in Canada have been from the U.S., but they've also been mostly from physical therapists who are paying $35 a membership. A lot of people have paid $35. The costs of just sending out basic information to people, just to the average consumer who writes to us, has been about $5 a package. In actual fact it is not at all a profit business. If you want to focus on that, then go ahead. But the issue is whether pinched nerves cause colic and bedwetting. That's the only issue. We can talk about AMA conspiracies, we can talk about vested interests if you like, we can talk about what Ron Slaughter said and I didn't say, and this is a very typical approach often. It is -- don't talk about what the issue is, talk to politicians, pay for massive publicity campaigns as the chiropractic pediatric group did in the USA Today. This will never resolve the issue. What will resolve the issue is both chiropractors reach out and limit themselves to safe, scientific care, will be seeing patients in the future, will be getting more benefits from referrals from other doctors, and will be accepted into the medical establishment. The only reason chiropractors have not been accepted before in the real sense, to move from that six percent to the 75 percent or so of people, is the fact that they have not stuck to the safe, scientific use of manipulation therapy.
"DC": Moving as you say to different PR moves and different attempts to influence the media, your organization has encouraged its members to utilize Consumer Reports articles for as much PR as possible. Dr. Slaughter, who I assume is a member of your organization, has suggested the same type of exposure for orthopractic would appear in the Consumers Digest article. Does the fact that Consumers Digest didn't even mention orthopractic take a little of momentum out of your marketing campaign?
Dr. Katz: I had no contact with Consumers Digest whatsoever personally. My impression was that the Consumers Digest article was mostly written before the orthopractic group came along. But Consumers Digest, having read the article, did in fact, make very clear -- that total yellow page they had on the side -- that they favored only those chiropractors who wanted to limit themselves to musculoskeletal care. Whether they called us by name or not, I think, was an issue. They were talking about orthopractic manipulation therapy, and they, in fact, warned the public very, very clearly against chiropractors who claim to treat anything other than musculoskeletal care. They didn't mention us by name, but they certainly described exactly what our guidelines are. Our momentum is not dependent upon publicity, our momentum is dependent on scientific evidence and people accepting that.
"DC": You are quoted as saying, "The Society is very well connected within the media. It's not an accident that the Wall Street Journal, "20/20," and other publications coming out are interested in this issue." This seems in conflict with your statement that orthopractic is purely scientific. Would you comment?
Dr. Katz: The media has been asking, many, many media people have been asking us for articles and for information, and we haven't had time. They're asking us for our scientific opinion and we're offering our scientific opinion to them. If I wanted to respond to every request for TV and just when I was on the phone now, I had a request from a national TV show to do an interview. I think every four or five days we get another request from a prominent or an important group in the media. Overall, I think we've given very little time. I haven't answered many, many requests because I don't think this is primarily a publicity issue. It's a scientific issue. I've spent much more time responding and talking with chiropractors who want to limit themselves to be orthopractic. I think it's really not a limitation, it's an opening of the whole scope of musculoskeletal care to move from the six percent to the 75 or 100 percent of people who have back problems. So we are a scientific body, and the media is extremely interested in that issue because the media wants to make a clear delineation what we have found between chiropractic as a philosophy and orthopractic as a form of treatment, which chiropractors, of course, practice.
Dr. Katz: But we're trying to promote a scientific viewpoint, so that's what we did. In actual fact now, we are not sending out that information anymore. Not that we disagree with it at the time, it's become unnecessary. It's become unnecessary because the media is, in fact, chasing us now. Anybody who's applied through our organization now, doesn't receive that anymore. It's not worth our time and energy anymore, because we're focusing more -- and I must say, not me in particular but a lot of other people, because I am medical director of the largest children's center in Canada and I'm teaching pediatrics, my time is very, very limited and this is not my primary interest in life at all in any way whatsoever. I happen to be in the forefront because of the issue of children, and that is going to become even more of an issue because the general chiropractic community has to appreciate that when they began to get heavily involved with children, and seminars, and claiming to treat all types of things with children, they provoked a very raw nerve within the medical community, which united the medical/scientific community in a way that they've never been united before. I think that if chiropractors by promoting claims to treat colic and bedwetting and anti-immunization, that fraction of chiropractic profession, when it did that, made a very serious tactical mistake. Because had they never done that, I don't think the orthopractic society or this ground swell would have ever come about.
"DC": You've been quoted as saying that you've invested over $50,000 of your own money in the orthopractic movement. That hardly sounds like a person who's got other things going, and not very interested.
Dr. Katz: No, I would say that over the years, going back over 20 years or so, on a personal basis if I added up all of the phone calls and the faxes and the postage, I've probably spent about $20,000 of my own money.
"DC": So that would be an exaggeration, that wouldn't necessarily apply to orthopractic?
Dr. Katz: No, I think the issue is that chiropractors have used those seven Ps to position themselves in a political way and in a powerful way, and a publicity way, and basically orthopractic chiropractors are being made aware of how to do the same. But at this point in time, I think that a lot of that has become redundant. The only way to position yourself to take better care of backaches, whatever the size of that market might be, is to gain respectability and be part of the scientific/medical community. As long as mainstream chiropractic stays with the six percent dragged there by claiming to treat colic and bedwetting, that's really where their stuck. If they can do what they do best, treat people for back problems, they will move out of that small, narrow corner and they will move into the scientific mainstream. I am very pleased to do my role to convince my own colleagues to do that.
You see, the only way a doctor knows if he sends a mother for a backache that the child isn't going to be treated for bedwetting is to know that that chiropractor is orthopractic. Now that there is a name which the chiropractor can attach to their professional designation, the doctor knows that, and once the doctor knows that, that's where the real shift in market and cooperation is going to happen. I think that things like talking about how to promote yourself have become largely unnecessary now. We are having so many requests for information, so many people in influential positions asking us what to do and how to do it and how can they identify only orthopractic chiropractors, that it's become really unnecessary to be over preoccupied with publicity. What there will be publicity about and continue to be about is the issue of chiropractors claiming to treat children for all types of diseases. Chiropractors tend to take total body x-rays of children, chiropractors who practice applied kinethesiology, chiropractors who try to pop kids necks, sacro-occipital techniques, selling tactics. I think the primary publicity focus as I see it in the future will continue to be basically what the Wall Street Journal and "20/20" and what Consumer Reports focused on and that is the question of chiropractic involvement with the children. I think that chiropractors ought to do one thing that will help their reputation more than anything else it would be to disassociate themselves completely from those chiropractors who are claiming to be chiropractic pediatricians and are claiming to treat by manipulation therapy everything from colic to bedwetting and ear infections. That will go more towards improving relationships with the medical/scientific community, and I think, in the end, the political community because there has been a real change. I'd say five years ago, any doctor who would criticize chiropractors would be accused of vested interest, would be accused of a plot, would be accused wanting their own share of the market or being narrow-minded. I know that because when I would talk about this issue with the media or anybody, three or four years ago, there was no point. Today, though since the issue of children became so dramatically increased in the United States, especially with these pediatric associations growing up and teaching seminars and so on, it's very, very easy to talk to the media right now because the media, the politicians, everybody clearly understands that infants and babies don't need their necks popped. They all understand that they don't want to pay for that through public funds. The mainstream chiropractic profession, even the ones who may believe that manipulation should be used to treat constipation or asthma or something else, would be wise to move away from the children's issue, because if they associate themselves with that issue and continue to make those claims, it's very clear that they're going to risk losing their entire profession.
"DC": When we initially spoke, you wanted to clarify some issues regarding the conclusions of the New Zealand commission report on chiropractic. Would you like to do that now?
Dr. Katz: I think that when people start attacking the messenger rather than the message you have to wonder how strong their arguments are. People have only said one thing about me, never what I said, but always quoting from the New Zealand commission of inquiry, and what the people should know is that a lot of what New Zealand had to say was based on false letters, misleading letters obtained by the chiropractors, submitted to the commission, regarding my professional claims to have worked with consultants for various governments. The true of the matter was that I did work for those consultants, and the truth was that the chiropractors admitted this in legal negotiations which concluded January 21, 1980 in which they agreed that the letters that they had were wrong and that I had "certainly functioned as a consultant at the very least with the administrations of Ontario and Manitoba" which I had said I did. So if people want to continue quoting the New Zealand commission, if they do so, and I have lawyers telling me this too, anybody who does in the future I'm not really interested in lawsuits, I don't think they solve anything, but the truth of the matter is that the New Zealand commission was presented with information which was false, and was subsequently corrected by the chiropractic group themselves, which obtained the initial information.
"DC": When you spoke before the Ontario Medical Association in Toronto, you made a statement, "The truth of the matter is that in 1980 the Canadian Chiropractic Association formally apologized to me in a successful, not unsuccessful lawsuit by admitting completely and fully that everything I said in New Zealand was 100 percent correct." Where is a copy of that?
Dr. Katz: I sent to you the statement from Mr. Pfephergrad of his negotiations. Now there was a confusion here because the Canadian Chiropractic Association was the group that solicited the additional letters that were not true, it was the Ontario Chiropractic Association which publicized those letters and the apology came from the Ontario Chiropractic Association.
"DC": So what you stated before the Ontario Medical Association was not quite correct?
Dr. Katz: Well, it's only incorrect in that the apology came from the Ontario Chiropractic Association but the letters were solicited from the Canadian Chiropractic Association, so I think it is basically correct. The copy is letter-dated January 21, 1980 from Mr. Pfephergrad regarding the Ontario Chiropractic Association, which they agreed to provide me with a statutory declaration as to names of all the institutions and people who were communicating with the contents of the letter.
"DC": You cite this letter from an attorney. Is this your attorney?
Dr. Katz: They offered the letter and I just said that's fine, forget it. They offered it and they said, "Mr. Marx said we will provide you with the statutory declaration." And I said basically, do what you like, send it if you like, do what you like ...
"DC": Did they send it to you?
Dr. Katz: I didn't ask for it in the end, I just said do what you like with it. I don't believe legal fights solve anything. I think that they admitted they were wrong, they met with my lawyer, they offered the statutory declaration, and that was the end of it.
"DC": Please correct me if I'm not understanding this. You went to the extent to hire an attorney, you went to the extent of filing a lawsuit or at least threatening to file a lawsuit, and you got all the up the table to the point where, according to your attorney, they were giving in to everything you wanted, and you turned them down.
Dr. Katz: Yes, well I didn't really turn them down I just said do what you like, and that was the end of it. I also felt after that I didn't know if they would continue to honor their agreement, and there was more legal expense involved in finally getting a printed paper and giving them a list of all the people that it had been sent to, and I just said, look, I don't know where they sent this. They could have sent it everywhere.
"DC": Do you have a copy of an agreement with them?
Dr. Katz: The copy is in what I sent you.
"DC": The only thing I see is a couple letters from your attorney.
Dr. Katz: If you read #2 it says, "You will be provided with a statutory declaration."
"DC": Right, but I don't see any signatures on it except those of your attorneys.
Dr. Katz: Then ask Charles Mark of Manning Bruce in Ontario. It's listed at the top.
"DC": So your attorney and you don't have a copy of the agreement but he does?
Dr. Katz: We never asked for anything more. Once they agreed ... It says here that they were in agreement that they certainly functioned as a consultant at the very least with the Ministry of Health in Ontario and Manitoba. And whatever they said in the end you have the letters from the the government, from the Ministry of Health in Ontario saying, "You are a consultant."
"DC": But getting back to this apology. The only thing I see here is a letter from your attorney to you, which frankly, I can hire my attorney to tell me that pigs can fly.
Dr. Katz: Check it out with the other side and see if they offered a statutory declaration or not. Go ahead.
"DC": Getting to some of the other issues the New Zealand commission brought up of you apparently pretending to be a chiropractor, a graduate from Palmer?
Dr. Katz: No, I never said I was a graduate from Palmer. I pretended to be a chiropractor. Excuse me, I might be wrong, I might have mentioned a school.
"DC": In the transcript on page 2,433 it does suggest that you did state that you were a Palmer graduate.
Dr. Katz: I might have said Palmer, yes. I don't remember that, but it certainly might be the case, yes.
"DC": So then in your dealings you did use a pseudonym and did act as if you were a chiropractor?
Dr. Katz: Absolutely, and when they published it, I was quoted in the largest Canadian newspaper as calling them "cowardly." He said that and then walked out the the room.
"DC": But why would you think it unfair if you had pretended to be a chiropractor?
Dr. Katz: Because I don't think that constitutes fraud, lies and deceit. I think that that constitutes a valid way, and objective way of gaining information that was not available saying that I was a doctor. And I also would point out to you that that information was accepted in two courts of law, in federal law and in provincial law, which qualified me to be recognized as an expert witness both in the Tartiff case and in the Lyons case. I'll also tell you that as a journalist in the past this is a commonly used method of gathering information, by journalists, by many, many people to call up and if you wanted to buy a car or something, you might call up and pretend you want to buy one when you really didn't or whatever. It's governments, journalists, people getting information ... Consumer Reports called up 400 people and pretended they were patients.
"DC": But there is a difference, and I've worked with various government agencies in the United States enough to know that pretending to be a patient or a potential purchaser of goods is very much different than pretending to be someone who's got some sort of degree or qualifications.
Dr. Katz: It's only different in the sense that if I pretended to treat somebody as a chiropractor, which I certainly never did. So if I put myself in the position of saying, "I am a doctor," and I am not, then that is totally different. I never did that.
"DC": The federal and state agencies I've worked with won't do that. Moving on, you've made quite a few remarks about the Canadian Memorial Chiropractic College. What is your opinion of the college, the education, the ability of its graduates, etc.?
Dr. Katz: I think that it is one of the best chiropractic colleges in North America, that it is moving reasonably fast towards trying to adopt some scientific principles. I think there are people within there who very much want to adopt a more scientific approach, and by and large the students I've met and have contact with there seem to be very sincere and very concerned about what their role will be in the future.
"DC": This is a shocking difference from what you wrote in the Medical Post article, where you said, "Allowing graduates of the Canadian Memorial Chiropractic College to have automatic access to OHIP, the right to use x-ray machines, as well as complete examinations of patients gives the public the false impression that these graduates are qualified to know what they are doing."
Dr. Katz: I think that that probably was a little exaggerated in what I wrote there. I certainly feel that they are perfectly qualified to practice chiropractic, but I think that the term "know what they are doing" would mean that if they felt when they graduated that they could use manipulation to treat asthma and bedwetting, and this is going to be publicly funded, I didn't think that was right. But I think that by and large if we look at all the chiropractic schools, I think that the graduates of that school have more of a concern from what I've seen of trying to practice in a scientific way than some other schools, without trying to put any school down in particular.
"DC": How did you feel about the retraction that the Medical Post made of your comments?
Dr. Katz: I had no hesitation in agreeing with it. I felt that that particular section was overstated and I feel that the school certainly does teach people how to practice chiropractic properly.
"DC": In the same article you claim that "The three largest groups of manual therapists have representation on the editorial board, these include the Canadian Orthopedic Manipulation Physiotherapists, the American Academy of Orthopedic Manual Physical Therapists, and the McKenzie Institute." Is this correct?
Dr. Katz: Yes, but the term representation is not correct because it implies that these three groups appointed a representative and in fact they did not appoint a representative. The way it would be better said is that the editorial board includes people who are members of these groups.
"DC": How did Stanley Paris and Rob McKenzie get to be on your editorial board?
Dr. Katz: I have known Robin for 20 years and he was one of the people consulted about the guidelines and Stanley Paris got involved late and was also consulted.
"DC": Is Stanley Paris a member?
Dr. Katz: He's a member of the editorial board.
"DC": Is he a dues-paying member of the Orthopractic Manipulation Society?
Dr. Katz: No, not yet.
"DC": How about Robin McKenzie?
Dr. Katz: I think that there are people on the editorial board who are not members, there are quite a few of them, some of them are there giving advice on issues when they in fact, themselves, don't practice manual manipulation therapy. Some of them are not named on the editorial board, but they are involved in public health, and different aspects of medical decision-making and care. So they are consulted, like I for example, don't practice manual manipulative therapy, but I'm on the editorial board.
"DC": In a paper entitled "Orthopractic Editorial Board Members" on your letterhead, you talk about the contributions that each of these people have made in writing the guidelines. And yet, when I've talked to Stanley Paris, he suggests that he hasn't written a thing for you.
Dr. Katz: No, because became involved very, very late.
"DC": But you still have him listed as one of the people who contributed.
Dr. Katz: Yes, but if you go further down it says that some of the people on the editorial board did not contribute. There's a qualification -- I don't know which letter you have of the editorial board -- but subsequently the information about the editorial board was revised around April ...
"DC": No, it's no the one revised May 1st and that's because you added some people who were not on the original list.
Dr. Katz: So it says there that there are people on the editorial board who did not contribute.
"DC": But on the original piece that you did, it didn't state that.
Dr. Katz: It wasn't added in because, as I say, we've made mistakes that we've had to clarify, and as we went along we clarified them.
"DC": Do you think this would tend to mislead members of the physical therapy profession?
Dr. Katz: That's possible. We don't mean to. We haven't had any complaints, really. So if people complain, that new addition will answer that comment.
"DC": Considering that Stanley Paris and Rob McKenzie have chosen not to be members of your organization, do you think that will affect the desire of physical therapists to become members when they recognize these two prominent individuals have decided not to?
Dr. Katz: Not at all, because we have an official endorsement from Robin McKenzie in which he writes that he will encourage all of his members to join. He'll probably be involved in the Australian group, but not necessarily in our group here. But the McKenzie Institute International, he has passed through our board and has sent us official letters saying he will encourage all 20,000 members to join. He is enthusiastic and Stanley Paris is on the constitutional committee. So I think he's equally involved and enthusiastic.
"DC": How would you explain their lack of desire to become official members?
Dr. Katz: It wasn't really required to be on the editorial board to be a member.
"DC": What percentage of your editorial board is made up of nonmembers?
Dr. Katz: I would say probably half. It depends on their expertise and how they saw themselves, really. It's really not an issue. If you consult someone for their scientific opinion or if they are contributing to you because of their role in dealing with the public or dealing with government, then they can contribute, they don't have to join your group.
"DC": So, you don't see a problem with allowing Stanley Paris, who's not a member, to chair the constitution and bylaws committee, which will be designing the rights of members?
Dr. Katz: I think that he will eventually decide one way or the other whether that is what he wants to do. No, we don't see a problem with that right now.
"DC": Why do you think he has chosen not to?
Dr. Katz: I don't think we've really discussed it that much. I think he wants to see how things go, and maybe he has other concerns. I think you should ask him that, really. It's not a problem for us, I mean we have people who are really not involved at all -- they're involved more in public health care policy decision, and yet they're contributing to the editorial board.
"DC": It's been suggested that the use of the term orthopractor by a chiropractor would mislead or deceive the public by giving the false impression of added qualifications or training. It has also been suggested that the use of the term by a DC may be, in fact, a violation of state or provincial statutes. Would you agree?
Dr. Katz: No, because all the chiropractor is doing by using the term orthopractic is deciding to limit his practice to musculoskeletal conditions. If a pediatrician limits himself to pediatrics, or a surgeon limits himself to surgery, they are not violating any medical laws. They're still doctors, and any chiropractor who decides to limit himself is still a chiropractor.
"DC": Right, but you're in encouraging your members to use that as official titles in advertising, in communication with insurance companies ...
Dr. Katz: It would not replace the term chiropractor, though. They would always say "chiropractor orthopractic." This is the same way we might say "physician, practice limited to children." We've never asked anybody to remove the name chiropractor.
"DC": In the June 19, 1994 "News Highlights for the Week" which is sent by fax to all of your members, it states, "President of Sascatchewan Chiropractic Association asked for speaker towards entire association joining movement." What does that mean?
Dr. Katz: I've never received it.
"DC": It's being sent out down the fax tree to all of your members.
Dr. Katz: I've never seen it. What does it say?
"DC": It says, "President of Sascatchewan Chiropractic Association asked for speaker towards the entire association joining movement."
Dr. Katz: Well, I guess it means that they want someone from the Orthopractic Society to talk to them.
"DC": With what end in mind?
Dr. Katz: To explain what orthopractic is, and see how interested they are. I think that's a very positive development.
"DC": When we inquired with the executive director of the Sascatchewan Chiropractic Association, his statement is that's "just crap."
Dr. Katz: I guess you'd have to find out again who is the fax tree referring to. I mean, it might be the association, it might be the registrar group, it might be a local city group. I have no idea, but you'd have to make sure you're talking to the same person, so you'd have to find out who wrote the fax, and find out who they communicated with, and talk to the same person. I'm not surprised to hear that, though, because I know that there have been requests that come from other provinces in Canada for people from the Orthopractic Society to speak to them.
"DC": In addition, your organization has suggested the involvement of various prominent members of the chiropractic profession including John Triano and David Cassidy, when neither of them are members or intend on becoming members.
Dr. Katz: No, we've never suggested that. I have never suggested that. I've never, I don't know who else has.
"DC": Then you may want to check with some of your members because it's going down your fax tree.
Dr. Katz: I think there have been inquiries, but until people decide what they want to do, there's a lot of enthusiasm in the Orthopractic Society and sometimes people get carried away a little bit and might jump to conclusion which are not yet true. I think those should be limited as greatly as possible because I don't think it's fair that people's names are used improperly.
"DC": You've been quoted as using Dr. Triano's name at the Back Society meeting.
Dr. Katz: I have not used Dr. Triano's name at the Back Society meeting that I am aware of. I didn't make any speech there ...
"DC": No, in talking with individuals at your booth.
Dr. Katz: People might have said, "Has he written to you?" or I don't know. I mean in private conversation. He has requested, on several occasions, information and has initiated all of those r
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