1. Introduction and acceptance of the Association of Chiropractic Colleges Paradigm on Chiropractic.

2. Clarification of terminology (e.g., spinal adjustment vs. spinal manipulation; clinical necessity vs. medical necessity, chiropractic vs. chiropractic medicine).

3. More research funding for models other than neck- and low-back pain and the medical research model.

4. Student loan forgiveness for chiropractic students willing to work in areas designated as MUAs/Medically Underserved areas.

The ACC paradigm was submitted early on in my participation. It was reaffirmed and introduced again in December 2001 by Dr. Fabrizio Mancini. The Commission accepted it.

Throughout the Commission document, all terminology referring to chiropractic met my objectives.

The research recommendations are all inclusive of chiropractic research in the areas of health and wellness, as well as quality of life issues.

The big barrier was related to the student loan forgiveness. One of the Commission members stated over and over again that Congress had determined that chiropractors were not primary care providers and, therefore, could not serve in the MUAs and receive loan forgiveness. At first, I was unable to discovery what "determination" this member was referring to.

Eventually, I uncovered the fact that two bills were submitted to Congress-S. 1281 and S.1533. The former included chiropractors in the National Health Service Corps/NHSC. However, the bill, as written, states that: "(1) Chiropractic doctors are skilled at providing a wide range of primary health care services, and (2) Chiropractic doctors are often the only providers available to provide health care in many rural areas.

The problem with this wording is that the Public Health Service Act defines "primary care health services" as health services involving "family medicine, internal medicine, pediatrics, obstetrics and gynecology, dentistry, or mental health, that are provided by physicians or other health professions."

Senate Bill 1533 was introduced by Sen. Kennedy and included chiropractic. Section 317 of that bill authorized the establishment of a demonstration project to provide for the participation of doctors of chiropractic and pharmacists in the Loan Repayment Program contained in section 338B of the bill. It is the intent of the committee in approving this demonstration project that participation be broad-based and comprehensive, and that the Secretary ensure the scope of the demonstration project reaches to all regions of the country.

My statements to the Commission have urged that chiropractors engaged in "MUA" services should be allowed to be health care team members as defined by the ACC Paradigm, with the practice of chiropractic a unique and clearly different approach to health promotion-disease prevention.

In my last communication with the Commission on this issue, I stated, "From the first meeting, my position has been that chiropractors deserve an opportunity to serve and prove that they have a unique and desirable approach to healthcare. Chiropractic has proven to be safe and effective and chiropractors are valuable health care team members. It's not possible to accept that individuals living in areas designated as MUAs are less deserving of free choice in health care than others... If, at the end of a demonstration project, chiropractic does not prove to be a service of choice; is not proven to be safe and effective, or have any value, then and only then do chiropractors not deserve to participate nor the public receive the service."

This needs to be accomplished legislatively. I've stated before the Commission that the Public Health Services Act was written when the medical model was the politically dominant one. Congress has become aware of the consumer movement's interest in non-allopathic approaches and care, and Congressional intent appears now to be responsive to meeting that need. A joint effort on the part of all of the national associations and chiropractic colleges could very easily define the practice of chiropractic for the 21st century.

I would like to publicly thank everyone who responded to my request to testify before the Commission. Those who testified, and their area of testimony, included:

*** Drs. Stuart & Theresa Warner, Chiropractic and Children;

*** Dr. Christopher Kent, the Council on Chiropractic Practice Guidelines and supporting research;

*** Dr. Patrick Gentempo, chiropractic philosophy and existing outcomes assessment tools;

*** Dr. Donald Epstein, wellness;

*** Dr. John Adams, information and dissemination issues;

*** Drs. Charles and Marion Tedres-Masarsky, Somatovisceral Aspects of Chiropractic, An Evidence-Based Approach;

*** Ron Hendrickson, ICA, background on chiropractic;

*** Dr. Robert Blanks, wellness research;

*** Dr. Brian McAulay, the need for college-based research funding;

*** Dr. Jerry Hardee, the role chiropractors can play as healthcare team members in MUAs;

*** Dr. Fabrizio Mancini, the chiropractic college curriculum and training of chiropractors; and Dr. Ed Owens, chiropractic research.

In addition, I wish to thank Ron Rupert of Palmer College for gathering and listing all subluxation related research documents; and the Chiropractic Leadership Alliance for taped interviews with three cutting edge chiropractic researchers (Drs. Holder, Morter, and Epstein).

Other individuals chiropractors and organizations offered oral and written testimony, as well. Chiropractic definitely was heard.

The complete WHCCAMP is available online at the Commission website at http://whccamp.hhs.gov/finalreport.html.