The True Value of Accreditation
Dear Editor:
Professionals are frequently offered courses, seminars, programs and even new organizations in nutrition that claim to "certify" the doctor in nutrition. It can be a confusing dilemma to decide what course of action to take. Should I be "certified" by this group or that group? Each of the options can cost time and money, but what are you actually getting for your efforts?
The ACBN has received a number of requests from professionals in the field to clarify the issue of "certification." The real program that separates the "wheat from the chaff' is accreditation. Is the certifying agency accredited? If the group claims to have accreditation status, who is the accreditation entity giving them this status? And who recognizes the accreditation agency?
Anyone can create a "certification" - provide a weekend seminar or have you fill out a number of forms, pay a fee and you are "certified." The real question we need to ask is, "Whom are you accountable to?" If the "certification" is made by and for a few people and they are not accountable to a higher authority, then you really need to give critical thought to its value.
The American Clinical Board of Nutrition (ACBN) understood this issue years ago. It is not enough to be "recognized" by your own colleagues. It is not enough or even appropriate to be "recognized" by your own member organization. That certification is, at best, a membership participation with no apparent or perceived value.
The ACBN worked to become accredited and to be held accountable to a higher authority than itself. The ACBN attained accreditation status from the National Commission for Certifying Agencies (NCCA), which is recognized by and accountable to the U.S. Department of Health and Human Services (HHS). This is the ultimate hierarchy of recognition. The ACBN is certified and therefore accountable to an "outside" agency: NCCA, which has no affiliation, connection or interest in anything to do with nutrition, or chiropractic, or medicine, etc.
This is your ACBN. If you are approached by or are interested in a group or organization offering certification in nutrition, ask them who they are accredited by. If they are accredited, ask who recognizes the accreditation agency. You will be amazed how few true accredited "certification" agencies there really are in nutrition.
The decision of which nutrition organization to pursue certification from should be based upon the professional maturity and responsibility of that agency. Someone other than your peers should be responsible to scrutinize your actions for the protection of the general public. The ACBN has made that commitment to the standards of NCCA and is proud of its on-going accomplishments.
Arthur Fierro, DC, DACBN, FACCN
President, American Clinical
Board of Nutrition
Answering the Unanswered Questions
Dear Editor:
The authors of "Unanswered Questions About Patient Care" (July 29 issue) are to be commended for confronting in their open letter what have become some of chiropractic's dirty little secrets. I would like to suggest that the authors may not be aware that at least some of their concerns have actually been addressed.
While the authors ask for a testable "definition" of subluxation, what they are really asking for are operational models. We do in fact have operational models of vertebral subluxation that are testable. For example, it has been stated that all models of vertebral subluxation have a biomechanical and neurological component.1 Both of these components are measurable and testable, and these measures can serve as outcomes assessments.
The most objective measure of biomechanical impropriety is via radiographic mensuration procedures, and such measures have been shown to be valid and reliable.2-3 Range of motion, both globally and intersegmentally, is also valid and reliable for measuring the biomechanical component of subluxation.4 Valid and reliable measures of neurological function also exist, such as somatosensory-evoked potentials, which are the only noninvasive way to measure nerve function directly.4 Indirect measures of neurological function, including surface electrode electromyography and thermography, are also available and have also been shown to be valid and reliable.4
If one is using the vertebral subluxation and its components as outcomes measures, then frequency and duration are determined by reduction and or resolution of the parameters being measured.5 And in terms of standards-of-care documents, the authors should also be aware that there are now three practice guidelines documents focused on vertebral subluxation included in the federal government's National Guidelines Clearinghouse.3, 6-7 Perhaps these guidelines should be incorporated into the curriculums of chiropractic colleges in an effort to fill the clinical void the authors contend exists.
This leaves only the authors' point that criteria to determine what techniques are appropriate for specific clinical presentations are needed. This is a valid point. Unfortunately, only a few proprietary chiropractic techniques have taken on a research agenda intended to begin addressing such questions. As long as the schools continue to teach such non-evidence-based methods, graduates will continue to use them. Curriculum committees should take a serious look at these issues.
Where the slope gets very slippery is in regards to what conditions are amenable to chiropractic intervention. Unfortunately, much of what we do know is based upon the common domain procedure of spinal manipulative therapy in the treatment of neck pain, back pain and headaches. While we contend that the majority of the manipulation being done is performed by chiropractors, this is rapidly changing and the research says little, if anything, about vertebral subluxation. It's simply based on gross, nonspecific manipulative procedures that block pain signals; this is what we have after over 100 years in the trenches. We desperately need leadership in this area.
What we need is to focus on measurable components of vertebral subluxation such as those mentioned above and see if those components can be reduced or improved, and if those improvements are coupled with positive health outcomes. If and when we do this, we will have closed the loop on the clinical meaningfulness of vertebral subluxation.
References
Matthew McCoy, DC, MPH
Associate Professor, Clinical Sciences
Life University College of Chiropractic
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