The World Health Organization (WHO) has begun the development of guidelines on chiropractic education and practice for its member governments. The WHO is working closely with the World Federation of Chiropractic (WFC), which has distributed the first draft to chiropractic colleges and all of its 81 member national chiropractic associations worldwide.
In 1999, the WHO, through its Office of Traditional Medicine (TRM), published guidelines on basic training in acupuncture. These guidelines, prepared for WHO member countries and their governments, provide for full education or alternatively basic training in which medical doctors and others may practice acupuncture.
The WHO is now working on developing similar guidelines for basic training in chiropractic and other "manual therapies." The WHO approached the WFC for advice and assistance. The WFC immediately saw that although this project offered opportunities for recognition and advancement of the profession in many countries, it also presented considerable risks.
The risk was that the WHO would consult primarily with medical doctors rather than chiropractors and, on a model similar to the acupuncture guidelines, would view chiropractic as a set of techniques that could be taught in a few hundred hours to medical doctors and others in countries in which the chiropractic profession was not yet established. The opportunity was that the WHO would work primarily with duly qualified chiropractors and then publish guidelines for governments worldwide supporting the development of appropriate chiropractic education and practice as an integral part of mainstream health care.
During the past four years, the WFC has worked with the WHO and has ensured that its primary sources of advice are appropriate experts in chiropractic education and practice. The WFC has emphasized repeatedly that chiropractic is a profession, rather than a set of techniques, and one that has developed an international standard of education.
The WFC also encouraged a decision by the WHO, made last year, that there would be two separate sets of guidelines for "manual therapies" - one for chiropractic and one for all other manual therapies, including osteopathy. The osteopaths continue to challenge that decision.
Until recently, it was unclear whether this project would receive the necessary WHO funding and proceed. However, in April 2004, the WHO confirmed that its staff was in the final stage of preparation of the first draft of the proposed guidelines. The WHO invited the WFC to provide a list of organizations and individuals with expertise to whom the draft guidelines should be sent during the consultation. In response, the WFC provided contact individuals and addresses for all WFC member associations, for accredited chiropractic colleges/schools, for accrediting agencies, and for a number of other organizations.
The WFC presented a report on the WHO chiropractic education guidelines at the European Chiropractors' Union Convention in Helsinki on May 21, 2004. It will also be holding an information session for representatives of accrediting agencies, colleges/schools and other educational organizations in Toronto, Canada on Wednesday, October 13, 2004, immediately prior to the WFC/Association of Chiropractic Colleges Education Meeting in Toronto, October 14-16, 2004.
From the WHO's viewpoint, manual therapies are one of the most popularly used forms of TM/CAM. It is therefore developing basic education requirements for safe practice, starting with chiropractic because it is "among the most popularly used" form of manual care and in many countries, unqualified practitioners are claiming to offer chiropractic services.
These guidelines deal with education and safety. The WFC has argued that they should also include information on effectiveness and indications for treatment. Safety and effectiveness should be dealt with together. While the WHO has declined to do this, the WFC will be reiterating its position for the inclusion of effectiveness information when we comment on these guidelines.
The WFC will report further as the WHO continues the process of developing these important guidelines that will be used by most countries around the world.
Paul F. Carey, DC
Immediate Past President,
World Federation of Chiropractic
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