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"OSCA Kicks Themselves (and Others) in the Teeth"

Dear Editor:

By advocating that their membership withhold dues until a merger between the ACA and ICA takes place, the Ohio State Chiropractic Association (OSCA) has, most likely unintentionally, provided reinforcement of an attitude that has been detrimental to not only them, but to any of our organizations, colleges or other societies that require membership dollars or donations to remain viable. The tacit message of the OSCA is: If an organization is not doing something that you want them to do, abdicate your financial support and/or personal involvement to force their action.

It is bad enough when individual doctors, perhaps uninformed on all the benefits that have resulted from organizational efforts, choose this action. It is absolutely unconscionable when a professional society such as the OSCA, which also faces challenges to the perceived value of membership, would engage in such heavy-handed tactics. At best, the OSCA's methods of advancing this cause (that of forcing a merger) were emotionally overcharged, ill-conceived, and lacking in rational thought. At worst, they were hypocritical by taking a stance which, if adopted by individual doctors in the state of Ohio towards the OSCA, would hinder the OSCA's efforts at increasing their own membership and, thus, their ability to protect the profession's interests on a statewide basis.

In a Utopian view, the ACA and ICA would merge, have a 100% membership rate, and share an agenda representing the interests of every doctor in the country equally, endlessly and successfully. In a pragmatic view, the ACA and ICA now, and most likely will forever, have strong fundamental differences of opinion. Regardless of our political, academic or philosophical persuasion, we are relatively similar in our basic desires: (1) to be able to put our knowledge to use in a manner that best serves our patients and in accordance with our licensure; (2) to be able to see those patients without being encumbered by unnecessary barriers; (3) to be paid equitably and fairly; and (4) to achieve a reasonable degree of personal, financial, and professional success.

Perhaps at some point, our political associations will realize that while these commonalities are few, the magnitude of their importance to our daily and practice lives far surpasses the differences we allow to drive the chasm between us wider. Until then, we are all better served by choosing the professional organization(s) that best represent our interests, sending them our dues, and even more so, by becoming an active participant in the advancement of those causes we feel are important. The fact is, no matter how much we may disagree with any given agenda of our collective organizations, we are far better off because of them, despite their differences, than we would be if each of us were left to simply wallow on our own.

Ronald D. Fudala, DC, DACAN
Cincinnati, Ohio

Barriers to National Unity

Dear Editor:

The Congress of Chiropractic State Associations has issued a resolution to work for unity of the national associations. At the last COCSA convention, I sat on a panel in a session devoted to professional unity. All the voices on the panel discussed the benefits of unity. Mine was the only one that injected caution. I am not against unity, per se. I am against unity when the needs for disunity have not been properly addressed.

There are three reasons for disunity that I would like to discuss. One is based on tradition. The various associations have a long history of existence. They have an identity and a presence. It would be hard for many members of these associations to see something with such a rich history dissolved. It could be considered a slap in the face to all of the men and women who fought so hard to build and protect the association. While this is a real issue and those are valid concerns, I don't believe they are valid reasons to perpetuate disunity.

A second reason is animosity. Members on both sides of the political and philosophical aisle have had their share of fights, and it may be unpalatable for some of these members to agree to work with those on the "other side." This is also a real, yet invalid reason, in my opinion.

The third reason is very real and one that will have to be resolved if unity is to occur, and if it is to last. Most organizations govern by pure majority rule. While this is a simple form of government, it has a number of flaws - the most significant being that those in the majority can silence the will and voice of the minority.

I have heard a pro-unity analogy of comparing one association consisting of members with two or more philosophical perspectives to be like our one nation functioning effectively with two political parties. The argument infers that individuals with different perspectives and agendas can work together and if it can work for our nation, it can work for a united association.

The problem with this analogy is that it ignores the two most important factors that make our country what it is; the Constitution and the Bill of Rights. The former provides a clear identity of our country and what it stands for. The latter protects specific rights of the minority from being controlled by the will of the majority.

Pure majority rule is bad government. When the white racial majority in our country exercised its control over the black racial minority, it nearly tore our country apart. Without proper protections from the Constitution and Bill of Rights, any majority - whether racial, religious, economic or other - could pass laws to control the actions of the minority.

If unity of organization is to occur within the chiropractic profession, and if it is going to stand the test of time, the new organization must adopt a chiropractic identity statement that can be agreed upon by all those who the new organization wishes to attract. It also must develop a Bill of Rights to protect the views and voices of any minority perspectives within the united association. It also would be a good idea to show respect for the history and traditions of the merged associations and their leaders.

If these steps are not taken, I am afraid that minority factions will get tired of not being treated fairly and will eventually splinter off - and once again, disunity will plague our profession.

Greg Baker, DC
Past President of the Georgia Council of Chiropractic
Chatsworth, Georgia

Stay True to Chiropractic

Dear Editor:

Usually, I look forward to reading Dr. Hammer's columns. His insights on soft-tissue rehab and pathology frequently deepen the reader's concept of things usually found complacent, like a sprain/strain. However, as I read "Was That X-Ray Necessary?" (Feb. 26 DC), I became reminded that the sports "chiropractor" is rarely interested in practicing chiropractic anything, and prefers working under a manual medicine paradigm. While the idea of a sports-minded chiropractor would be something worthwhile, a pain and symptom outlook specific to athletes is simply (and un-uniquely) physical therapy or manual medicine.

Chiropractic has historically specified itself as going beyond symptomotology and looking at structure as well as function in an attempt to assess the overall health of the patient. Comments such as "Disc bulges, facet joint degeneration, end-plate changes and mild spondylolisthesis represent part of the aging process and are of only modest value in diagnosis or treatment decisions" show a certain shortsightedness on Dr. Hammer's part. While these signs can be poor pain predictors, these structural changes are in and of themselves relevant findings, even in the absence of pain; notwithstanding the fact that many of the previously mentioned findings are a response to asymmetrical loading, which can be detected and prevented with the use of routine X-ray.

While I agree that X-ray has become like so many outcome studies in chiropractic, not used properly in a test, retest manner; to limit its use to a "red-flag" only exclusion tool is to discount much of the progress, published peer-reviewed, chiropractic literature, and structurally based chiropractic practice that is currently taking place. The conversation regarding its specificity to predict pain should be the end of the manual-medicine conversation, and the beginning of the chiropractic one.

As is apparent in his refusal to allow his dentist to take the routine films necessary to make a complete clinical impression, Dr. Hammer holds opinions on things he is not necessarily an expert on. (Many dental conditions are asymptomatic until their end-stages as well. Maybe they are not as focused on pain as they should be.) I refer Dr. Hammer to the PCCRP (Practicing Chiropractors' Committee on Radiology Protocols) Web site (www.pccrp.org). These are guidelines produced by the most published chiropractors in history, regarding the appropriateness of chiropractic X-ray.

I urge Dr. Hammer to continue his work educating the profession regarding the health and function of soft tissue. It is an important topic to a structurally based profession which sometimes gets hung up on the bones. I also encourage him to revisit the uniquely chiropractic aspect of his paradigm. Continue to ask: "What makes me different?" If the answers become increasingly difficult to find, perhaps there's another conversation we as a profession need start having.

Aaron L. Wiegand, DC, CCST
Phoenix, Arizona