Viewpoint

The dialogue continues ...

A recent issue of Dynamic Chiropractic published a response by James D. Edwards, D.C., ACA Chairman of the Board, to an "Open Letter to the Profession" written by Michael S. McLean, D.C., ICA Legislative Chair, which published in the February issue of The Chiropractic Journal. The dialogue continues in his issue, with answers from Dr. McLean and Christopher Kent, D.C., member of the Board of Director of the World Chiropractic Alliance.

From Dr. Michael McClean:

I never said ICA "backed out" of our agreement with ACA & WCA. The agreement was broken by some person or group who has yet to own up to it: that person or group who gave the flawed language (without the term "subluxation" in it) to be introduced in Congress.

I know neither the ICA nor the WCA did this. Since there were only three players involved, the only other one who could have asked Congress to introduce the flawed language was the ACA. We have no proof that the ACA submitted the language without "subluxation," but the Department of Defense bill that ACA had introduced the previous year also left "subluxation" out of the language.

Jim, the link you provided to Congress' website references the wrong bill, HR3447. The language in question is found in HR 2792. Unfortunately, the site does not "verify" who introduced the flawed language, just that HR 2792 was introduced by your former Congressman.

I am curious why you believe my remarks are a "case in point ... for why a merger of the ACA and ICA is so badly needed." Is it because with a merged organization I would be silenced? Or criticism of the ACA leadership would be silenced? I believe our disagreements point up precisely the reason we need the ICA more than ever. Most people would think merger makes sense when two organizations share common core values, not when they have core disagreements.

Look at the issue of CCE. ACA Executive Director Cuneo says the ACA fully supports CCE in their revocation of Life's accreditation. ICA immediately called for an investigation into the circumstances of the decision. Now a Federal judge has ordered Life's accreditation restored because he is convinced there is a substantial chance that the revocation was not legal. He has found sufficient merit to order the case be heard, and the CCE will now be on trial.

How could ACA support an action that destroys the largest chiropractic college in the world? It's incomprehensible! And now that the CCE is in the dock, will ACA still support it? If CCE is found to have acted illegally, will ACA still support it then?

FCLB is cooking up a scheme to control continuing education nationwide, in conjunction with CCE. ICA is trying to alert the profession to this coup. ACA supports it, as far as I can ascertain.

Merger? Not in my lifetime. Unity in action, yes. On issues where we agree. Joint meetings to iron out problems behind closed doors and not air our dirty laundry in public? Sure. But merger? Jim, D.C.s join the ICA because they don't like the policies of the ACA, not because they want to support them.

Work with the other national organizations for the good of the profession which ACA represents. Hammer out issues we can agree on, and agree to disagree on the rest. There is too much to accomplish to get hung up on egos. The ACA can contribute so much to the progress of the profession. The other three national organizations have joined in a Coalition to act in unison on issues we agree on. Why not join the rest of the profession? I'd bet even a majority of the ACA members would be in favor of it.

It's time to move on. Work with us.

From Dr. Christopher Kent

Thank you for sending the advance copy of your response to Dr. McLean. Although we perceive the events surrounding the VA bill quite differently, it is not my intent to continue this "he said, she said" exchange. My feeling is that doing so would only serve to prolong a course of action that has had a damaging effect on the profession. The bill has passed, and the committee has been appointed. It is time for all parties to stop claiming credit or laying blame. Instead, I would like to share my thoughts with you concerning my observations after 30 years in chiropractic.

For three decades, I have watched competing factions within the profession engage in self-destructive behavior. This began when, as a student, I was hired by ICA to develop their Medicare seminar program after unsuccessful negotiations with ACA. This was followed by the struggle between the former ACC and CCE to obtain recognition for their accrediting agency. I have at one time or another been a member of ACA, ICA, FSCO, and WCA. The failed ACA/ICA merger effort is a vivid memory, as is the accreditation struggle involving SCASA and CCE.

In recent months we have seen the largest chiropractic college in the world virtually destroyed by withdrawal of accreditation. In response, lawsuits have been filed, and many innocent students suffered. Now a federal judge has issued an injunction restoring accreditation, and the agency has filed an appeal. The economic impact of this debacle is at least tens of millions of dollars.

During these thirty years, I have been privileged to work with committed, passionate chiropractors, all sincerely believing that their course was "what's right for the profession." I have seen the profession from many perspectives, as a chiropractic college faculty member, field practitioner, researcher, and politico. I've seen chiropractors pitting themselves against other chiropractors in classrooms, state board meetings, political meetings, and even the UN.

In the words of diet guru Susan Powter, "It's time to stop the insanity."

The chiropractic profession is at a critical juncture. American culture is embracing our philosophy, and crying out for leadership. Economist Paul Zane Pilzer has predicted that the wellness industry will become the next trillion-dollar player in the marketplace. We have an installed base of 60,000 licensed practitioners. An opportunity of this magnitude has never presented itself, and the next such opening may not occur in our lifetimes. Only we can screw it up. And that's precisely what we are doing.

What can be done? Will mindless chanting of the "unity...unity...unity" mantra solve the problem? Will each organization attempting to out-maneuver the other work? Will rants from bully pulpits win favor with field doctors and legislators? How about one organization attempting to devour the others? Been there. Done that. For over 100 years.

We are living with the results of these failed strategies. Who is right? Who really knows "what's best for the profession?" Well, about 50,000 have already voted with their feet: no one. The overwhelming majority of practicing chiropractors do not think ANY of our national organizations are worth their time, talent, and money.

Let's look at some examples. When many of us were still neophytes in this profession, "compromise" Medicare language was drafted and passed into law. It provided for "manual manipulation of the spine to correct a subluxation demonstrated by x-ray to exist." It DID NOT explicitly state that only a chiropractor could provide that service. It used the common-domain term "manipulation" rather than the specific term, "chiropractic adjustment."

Just words, you say? Or how about the tired old bromide, "It's a foot in the door."

Because of this imprecise language, we now are involved in the HCFA lawsuit-a financial black hole with no resolution in the palpable future--that's draining precious resources that could be used to support our colleges, research efforts, and public awareness programs. As with the CCE/Life issue, only the lawyers have benefitted.

The DoD bill, much lauded by ACA and ACC, and a proposed model for all federal legislation, DOES NOT mandate direct access beyond the demonstration project, DOES NOT explicitly include care for vertebral subluxation, and limits us to care of neuromusculoskeletal conditions.

The fruit of this folly is that except for a handful of demonstration sites, the services of a chiropractor are available ONLY BY MEDICAL REFERRAL. The military's perception of chiropractic is horrifyingly narrow. See http://www.chiroweb.com/archives/21/02/02.html "Most sites still utilize a referral system. In which the medical doctor makes an initial diagnosis and then refers the patient to a chiropractor for additional care." What training does an MD have in chiropractic assessment methods? And what about the handful of sites that offer direct access? A potential patient may see a chiropractor for "musculoskeletal complaints." Note that the "neuro" prefix is gone, and subluxation is never mentioned.

After HCFA and Trigone, will we be suing DoD next, should they decide that there is already the availability of treatments for "musculoskeletal symptoms," including "manipulation" by DOs and PTs?

Jim, that's the BIG difference between ACA and ICA and WCA. ACA says, "the subluxation principle SHOULD (emphasis added) be reiterated in federal legislative efforts." I cannot speak for ICA. However, for WCA, "should" isn't good enough. To this end, WCA has adopted a legislative policy that everyone can live with:

1. Scope of practice determined by state law for the correction of vertebral subluxation(s) and/or care for neuromusculoskeletal conditions.

2. Recognition of vertebral subluxation as a reason for chiropractic care.

3. Exclusion of drugs and surgery.

4. Direct access to chiropractic care, without referral by any other provider.

5. Participation in government-sponsored programs be open to any willing licensed chiropractor.

See http://www.worldchiropracticalliance.org/positions/legislativepolicy.htm

Success will not be achieved by attempting to force the entire profession to adopt a single practice style, technique, or organization.

Jim, you and ACA claim to favor unity, yet ACA was the only national organization to refuse participation in a joint legislative conference. ICA invited ACA, FASCO, ICA, and WCA to participate. Everyone participated, except ACA. This is particularly egregious, since the meeting was held in Washington, D.C., making it possible for ACA to participate without travel expenses or a significant time investment.

It has also been suggested that ACA may withdraw from the NCLF-one of the most effective organizations in the history of chiropractic. NCLF has brought together allies and traditional adversaries. It's a forum where we can talk to each other, argue, and identify areas of commonality. Conflict resolution protocols have been developed which have worked well.

It is disingenuous for ACA to claim to be in favor of unity or merger, while refusing to participate in efforts toward unified legislative action.

In the February 2003 "Chairman's Message," you wrote, "the ACA will no longer accept "no" for an answer from the ICA because, in the final analysis, it is not the ICA's right to say no."

Come on Jim! Passionate as you may be about ACA, no organization has the right to attempt to control another! And no organization has the moral right to terminate dialogue because they don't always get their way.

I believe it is possible for the interests of all but the most extreme chiropractors to be accommodated, provided there is tolerance, respect, and dialogue. If we stop talking to each other, we are defeated before we begin.

Jim, I know what doesn't work. Bullying doesn't work. "Hit pieces" in the chiropractic media won't work. The premise that ACA can conquer the profession by absorbing ICA against its will and ignoring WCA won't work.

In the December 2002 "Chairman's Message," Larry Markson wrote, "Each keeps trying to win the war by negative press about how wrong the other guy, by slandering those who don't think like us, and by sending conflicting bills to legislative bodies...The ACA, I am told, wants more 'control' because they represent a larger constituency than the ICA or WCA. While I can understand that thinking, I also know that no one will agree to it, so scrap that idea and create a new one...Unity does not necessarily mean merger...as long as the umbrella over our heads loudly and clearly proclaims chiropractic principle-that we give adjustments, not manipulations, and that we render holistic health care to our patients, but leave the treatment of disease to our medical brethren."

So what can we do?

Instead of expecting an overnight miracle, let's commit to:

 1. Celebrate our diversity. In my communications with other health organizations in the UN, the issue of chiropractic identity often arises. When asked about schisms and apparent contradictions, my answer is simple: "Some chiropractors specialize in caring for patients with musculoskeletal problems. Others focus on wellness and quality-of-life issues. Our unique contribution is the adjustment of vertebral subluxations, which disturb the function of the nervous system."

Thus far, no one appears to be "confused" by this, any more than they find the fact that some dentists fill cavities while others specialize in orthodontics to be "confusing." Confusion only comes into play when one brand of chiropractic is represented as the one and only, with everyone else branded wrong.

2. Communicate. We must continue meaningful dialogue, and have the maturity to realize that we are not going to agree on everything. The question we must ask is, "Can other points of view be accommodated without compromising my constituent's interests?"

There will be contentious moments, raised eyebrows, and raised voices. The process will not be easy or painless. Yet the alternative remains unacceptable.

 3. Seek to define core values. True unity will occur naturally when common core values are defined an embrace. We've taken a few baby steps in this direction, such as adopting the ACC Paradigm. We still have a way to go.

 4. Do not confuse goals with strategies. Confusing a strategy for a goal means closing the door to the consideration of other strategies, which may be more effective. "Merger" is a strategy, not a goal. "One unified national organization" is a strategy. What is our goal? How do we define "unity?" What are the most effective strategies to achieve our goals?

 5. Remember the patient. This is not about insuring the employability of chiropractors, or even "what's best for the profession." It's about working to ensure that lifetime, subluxation-based wellness care is available to any person who wants it. What's best for the profession is what is best for the patient. Once we realize this, our market-share will explode.

 6. Seize the wellness opportunity. Assume the leadership role of the wellness revolution. Ensure that chiropractic's unique contribution to unleashing human potential is at the core of wellness strategy. We need not copy the medical models of early detection and disease prevention. We can command the proactive wellness movement, which is not competitive with medicine in treating disease. See me recent article in The Chiropractic Journal, which discusses this in greater depth.

 7. Get over the past. The more we rehash moot issues and perceived failures, the less energy we can focus on creating a positive future.

 8. Create a positive future. We must focus on how we can create value for those who see no compelling reasons to invest in a national organization.

Jim, we can all have our wants and needs effectively addressed. Legislation can be crafted that provides for the needs of chiropractors specializing in neuromusculoskeletal disorders, and chiropractors who offer subluxation-based wellness care. In fact, I have heard of patients who have two chiropractors -- one to treat an injury and one for wellness care. This is no stranger than there being synergy between an orthodontist and an endodontist.

Wouldn't it be wonderful if chiropractors with different perspectives, practices, techniques, and talents referred to one another for the benefit of the patient, rather than vilifying one another, and referring only to medical doctors?

Instead of re-working the failed strategies of the past, or closing the door to strategic alternatives, let's look outside the box for the solution that is "naturally right" for everyone.

As Gandhi wrote, "We must become the change we want to see."