December 2003

To all doctors of chiropractic

Your help is needed IMMEDIATELY!

The Council on Chiropractic Education (CCE) has posted three proposals involving:

1. Adoption of the ACC diagnosis policy, which the Chiropractic Coalition opposes.

2. Mandatory physiotherapy instruction at all chiropractic colleges.

3. A provision that would permit a waiver of the two‑year requirement if an institution loses accreditation, but impose a minimum wait of a full year for reapplication (few schools could survive a whole year without accreditation).

These proposals are compelling evidence that the CCE is proceeding with its "physician" agenda and must be vehemently opposed! We must FLOOD the CCE with our comments.

Please submit your comments to the CCE as soon as possible. The following "talking points" and the sample letter at www.worldchiropracticalliance.org/news/cce‑proposals.htm can help, but it's best if you put the comments in your own words, and be sure to include your name and contact information. Send your comments to:

The Council on Chiropractic Education 8049 N. 85th Way Scottsdale, AZ 85258‑4321. Telephone: 480/443‑8877 Fax: 480/483‑7333 e‑Mail: cce@cce‑usa.org

Also, send a copy of your letter to: Mr. Rod Paige, U.S. Secretary of Education, Department of Education, 400 Maryland Ave. SW, Washington, DC 20202 ... and to the World Chiropractic Alliance.

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>>> TALKING POINTS

Proposal 1 ‑‑ Definition of Diagnosis

Background: This proposal adopts the definition of diagnosis developed by the ACC, which states that "a diagnosis by a doctor of chiropractic includes obtaining pertinent patient history; conducting physical, neurological, orthopedic, and other appropriate examination procedures; ordering and interpreting specialized diagnostic imaging and/or laboratory tests as indicated by symptoms and/or clinical findings; and performing postural and functional biomechanical analysis to determine the presence of articular dysfunction and/or subluxation."

Reasons for objecting to this proposal:

This definition:

a) Could be interpreted to mean that chiropractors MUST incorporate all the listed tests or procedures into their practice. This could be corrected by changing "includes" to "may include" or by specifying that "D.C.s are not required to use all of the diagnostic and treatment modalities set forth in this section" (as in the California chiropractic licensing statute).

b) Could make doctors who limit their practices to the detection and correction of vertebral subluxation vulnerable to accusations of malpractice, board complaints, and exclusion from managed health care programs.

c) Does not include or mention spinal analysis or palpation of the spine.

d) Does not provide latitude for the unique needs of each patient and replaces the judgment of the attending doctor with a checklist of orthopedic and neurological tests that may be irrelevant to the determination of neurological function in the context of subluxation.

e) Characterizes subluxation as nothing more than a postural or biomechanical problem. Eliminating the neurological element not only jeopardizes the doctor who uses instrumentation to assess neurological function, it contradicts the ACC statement concerning organ system function and general health. This could be corrected by changing the wording to: "performing appropriate postural and functional biomechanical analysis, and/or using specialized procedures to determine the presence of articular dysfunction and/or subluxation and its resultant neurological dysfunction."

Proposal 2 ‑‑ Physiological Therapeutics language

Background: This proposal would mandate that "physiological therapeutics" instruction be included in all accredited Doctor of Chiropractic programs.

Reasons for objecting to this proposal:

a) The use of adjunctive procedures is regulated by state law. The use of procedures outside the state scope of practice may result in charges of engaging in the unauthorized practice of medicine, and tort liability.

b) Although permitted in some states, the inclusion of physiotherapy as a requirement in chiropractic education could cause confusion about scope of practice.

c) A growing body of scientific literature reports that passive physical modalities are of little or no value in addressing musculoskeletal pain, and may actually prolong disability. Evidence for this conclusion was provided in the Clinical Guidelines for the Management of Acute Low Back Pain, produced by the Royal College of General Practitioners in Great Britain and The AHCPR Guideline for Acute Low Back Problems in Adults. The proposal gives an implied endorsement of the procedures by the CCE, which contradicts this evidence and would therefore not be in the best interests of the profession or the patients it serves.

Proposal 3 ‑‑ CCE Policy; Exceptions and Waivers to the Standards

Background: The provision that would permit a waiver of the two‑year requirement if an institution loses accreditation. However, it goes on to state that: "under no circumstances will the reapplication waiting period be less than one (1) year from the date of the COA's denial of reaffirmation of accreditation, nor does the granting of the exception or waiver of this procedural process assure that the DCP is in compliance with the Standards." This eliminates the ability to grant waivers for reapplication of less than one year.

Reason for objecting to this proposal:

Few colleges could survive the loss of accreditation for a full year. Even if the reasons for the loss of accreditation were later found to be unfair, biased or otherwise improper, the school would be severely damaged. There is no compelling reason to deny a college the right to seek a waiver in less than a year.