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Are ICA and ACA Members Really All That Different?

Dear Editor:

I recall a few years ago this subject was discussed by past ACA Chairman of the Board, Dr. James Edwards. His main points were that the guiding documents of the two organizations are very similar – both mentioning the subluxation as a key component of treatment and both shunning the use of surgery and drugs. But let's drill deeper into what goes on in the offices of your average ACA and ICA members (and members of the NCA [No Chiropractic Association] who lean toward one of the national organizations).

Do members of all three groups recommend, use and/or sell therapeutic items, such as vitamins, minerals and other supplements, in their offices? According to studies published in many chiropractic publications, about 90 percent of chiropractic physicians utilize supplements of some sort in their practices. We call them supplements, but what are they, really? According to the FDA's definition of a "drug," they are all drugs. (The FD&C Act defines drugs, in part, by their intended use, as "articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease" and "articles [other than food] intended to affect the structure or any function of the body of man or other animals.")

The ICA Practice of Chiropractic statement includes the following: "The ICA considers the therapeutic use of drugs and surgery to be the practice of medicine." Many in the ICA and ACA recommend and/or sell non-prescriptive drugs. Is it unethical, according to the documents of the ICA and ACA, for one of their members to sell or recommend omega-3 fatty acids or vitamin A? What percentage of ICA / ACA doctors aren't selling or recommending "drugs" to "cure, mitigate, treat or prevent a disease "(or dis-ease)? A drug is a drug is a drug, regardless of its current prescriptive or non prescriptive status, according to the FDA.

Should the ICA and ACA consider filing ethical violation charges with its respective ethical committees for members selling a "drug" in their office? Who knows more than chiropractic physicians about non-prescriptive drugs (supplements, vitamins, etc.) and natural alternatives among primary contact physicians in the U.S.?

So, are ICA and ACA members really that different in how they run their offices related to "drugs"? Both groups' members, according to the FDA and most state pharmacy laws, are "drug" pushers. And how many ICA and ACA members recommend their patients drink plenty of water? Is water a drug? Sure; place it into an injectable vial and it is a prescriptive "drug." (Same with vitamins C, A and B6.) Water a drug – really?

Do many ICA and ACA members perform "surgery"? Acupuncture was considered a type of surgery in many jurisdictions for many years and may still be by a few. The recent legal opinion in Texas discussed the history of this issue and explained the legislative change that took it out of the "surgical" realm. But in its purest form, sticking a needle in someone is a "surgical" procedure, isn't it? How many ICA and ACA members perform acupuncture?

Manipulation under anesthesia is also considered, according to the CPT code manual, a form of "surgery." If an allopathic physician numbs a sacroiliac joint of an ICA or ACA member's patient, or a patient presents after taking Vicodin, or the area is numbed by acupuncture, is the member guilty of performing "surgery" if they adjust them?

The Texas appeals court also stated that needle EMG was actually a form of surgery. Well, kind of; it depends on the shape of the tip of the needle, something that can't even be seen with the naked eye. Needle EMG, acupuncture and MUA: all forms of "surgery"? How many ICA and ACA doctors perform these procedures?

My last observation concerns comments from both organizations concerning their doctors' scope of practice. The ICA states, "The International Chiropractors Association recognizes that the various state legislatures have the right to grant Doctors of Chiropractic the option to qualify, and thereafter utilize procedures which are not within the Association's view of the parameters of the clinical application of traditional chiropractic." The ACA makes a similar statement and an additional policy states, "[I]t is the ACA's position that the scope of practice of chiropractic physicians and post-doctoral chiropractic specialties should be determined by the education and training provided within CCE-accredited institutions and/or the education and training provided through post-graduate / post-doctoral courses and specialties."

Don't both of these statements allow their organization's respective members to obtain training outside their national organization's policy statements / philosophies? Don't the statements of the ICA / ACA allow a virtually unrestricted scope of practice if the doctor has the proper training and the state legislature allows it? Haven't the overwhelming majority of ICA / ACA members taken advantage of what is allowed by their professional organizations and state legislatures? Don't many ICA / ACA members have additional training to practice outside of "pure" chiropractic?

Maybe a few don't, but I'll bet if we walked into the offices of ICA and ACA members across this country, we would see they are doing a lot more than adjusting spinal subluxations. Do they prescribe, recommend and distribute "drugs," according to the FDA's definition? Do some perform "surgery"? They sure do.

Can our national organizations continue to play this "drugs and surgery" game and not expect the downward spiral of our profession to continue? Can't we all agree we want to do everything we can possibly do to keep our patients away from dangerous drugs and dangerous surgery?

If a patient needs a "drug" (supplement, vitamin, nutrient, non dangerous prescriptive item,) wouldn't you want a properly trained chiropractic physician prescribing it? Aren't ICA and ACA members already being trained in ancillary procedures purists have labeled for decades as "not chiropractic"? So, is there really that much difference in what ACA members and ICA members are doing in their offices? And finally, can we afford the continuous internal semantics battles while other professions circle our wagons? Can we, really?

Dave Dickerson, DC
Salida, Colo.

Taking on Medicare

Dear Editor:

Regarding the comments submitted of late by my colleagues across the country, it must be obvious to all that the anti-chiropractic bias coming from the Centers for Medicare & Medicaid Services needs to be opposed with all the resources at our disposal. It will continue to pick us off one by one and region by region. The CMS must be convinced or forced to relax its documentation and necessity guidelines for chiropractic services.

The ACA should take the lead in this and challenge these discriminatory practices in court. Any chiropractor who does not belong to the ACA or the ICA is a freeloader and needs to get on board.

Tom R. Fontenot, DC
Groves, Texas