April 2004

WCA Board member attends WHO Consultation

A special report by Yannick Pauli, D.C., WCA International Board of Governors

NOTE: Dr. Pauli participated in the World Health Organization [WHO] Consultation On Proper Use of Traditional Medicine and Complementary Medicine by Consumers, held in Milan, Italy, Dec.1‑3 2003, and filed this report with the WCA. The WCA is a Non‑Governmental Organization [NGO] associated with the United National Department of Public Information and has previously worked with WHO representatives on chiropractic‑related issues. For more information about the WCA, the United Nations and WHO, visit the WCA website at www.worldchiropracticalliance.org.)

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Representatives from 30 countries met in Milan, Italy late last year to review and make recommendations on the second revised draft of the "WHO Guidelines on promoting proper use of traditional, complementary and alternative medicine by consumers."

Dr. Sassan Behjat, Coordinator of the National Center for CAM, Ministry of  Health of United Arab Emirates and Chairman of the Consultation, Dr. Xiaorui Zhang, Coordinator, WHO Office of Traditional Medicine and Yannick Pauli, D.C., member of the World Chiropractic Alliance International Board of Governors.

This second draft was prepared by the Karolinska Institute (Sweden), on the basis of suggestions and recommendations made by more than 500 experts in 107 nations.

The objectives of this WHO Guideline are to:

***  Provide an overview of important areas for ensuring proper use of TM/CAM by consumers,

***  Provide general principles on how to develop reliable TM/CAM information,

***  Give recommendations on topics to be included in consumer's information promoting the proper use of safe and effective TM/CAM.

In attendance were 78 participants from Bahrain, Belgium, Brazil, Canada, China, Congo, Cuba, Ecuador, Egypt, France, Ghana, Ireland, Italy, Korea, Kyrgyzstan, Madagascar, Myanmar, Nigeria, Philippines, Russia, Saudi Arabia,  Singapore, South Africa, Sweden, Switzerland, Thailand, Ukraine, United Arab Emirates, United Kingdom, and the United States.

Participants represented various governmental bodies and professional associations, including chiropractic, osteopathy, homeopathy, traditional medicine, traditional Chinese medicine (including acupuncture and moxibustion), herbal medicine, anthroposophical medicine, and shiatsu.

I was present at the Consultation representing the World Chiropractic Alliance (WCA). Also present from the chiropractic profession were: Dr. Paul Carey, President, World Federation of Chiropractic (WFC); Mr. David Chapman‑Smith, Secretary General, WFC; as well as Dr. Jean‑Pierre Meersseman, a chiropractor practicing in Italy.

The meeting started with opening statements from representatives of the Health department of the Region of Lombardy (Italy). The Government of Lombardy hosted the Consultation.

Dr. Sassan Behjat, Coordinator, Office of Complementary and Alternative Medicine, Ministry of Health, United Arab Emirates, was elected chairman of the Consultation.

The consultation process started with presentation from China, Canada, and Kyrgyzstan on their regulation of medication therapies, such as herbal medicine.

At the start, the Consultation was very much oriented toward "medication Therapies" (herbal medicine, homeopathic remedies and dietary supplements). As the meeting went along, a better balance was created between the former and "non‑medication therapies" which include those therapies or profession that do not use medication to provide health care. Chiropractic is included in this category.

The whole process was pretty straight forward. Each chapter of the Draft was reviewed and input provided by the different participants. It was very interesting to be exposed to the points of views of such a variety of cultures.

Although the objective of the Consultation was to make recommendations on the proper use of Complementary and Alternative Medicine by consumers and involved many professions and therapies, I feel that our presence was of importance. One incident illustrates this very well.

The second draft addressed the issue of contraindications of medication therapies. Many participants felt it was also appropriate to address non‑medication therapies and the WHO staff drafted one page on that subject. On the chapter on contraindications, it was mentioned that "manual treatment of chiropractic can cause paralysis in the hand of unskilled people" and that "manipulation cannot be used in fractures, serious lesions and osteoporosis."

I, of course, objected strongly to these sentences and the paragraph was eventually dropped and replaced.

This incident illustrates the importance of a subluxation‑based chiropractic presence in those meetings. What would have happened if the previous sentences had gone unchallenged and published in an official document of such a prestigious institution as WHO? Moreover, it illustrates as well the need for further education and collaborative work between our profession and officials of WHO.

Interesting points

A number of interesting points came out of the Consultation.

Although the majority of the participants held degrees from conventional medicine (M.D., Ph.D. or Dr. of Pharmacy), most of them ‑‑ especially those from Eastern and African countries ‑‑ are:

***  Very aware of the difference of paradigm between the treatment of disease vs health, wellness and quality‑of‑life enhancement;

***  Very critical of the assumption that western science be used as the gold standard by which TM/CAM must be investigated;

***  Very aware that the lack of  "scientific" (according to western definition) evidence is more related to a lack of appropriate methodologies to assess TM/CAM than to any other factors;

***  Convinced that hundreds of years of practical clinical experience and observation are worth as much as, if not more than, any double‑blind, randomised, clinical trial, and forms an excellent source of scientific evidence;

***  Very aware of the unity of body/mind/spirit.

The Milan Consultation was an excellent portrayal of the differences in paradigm between those whose perspective is vitalistic, health‑oriented and those embracing a mechanistic treatment‑of‑disease.

As mentioned, many experts pointed to the lack of appropriate scientific methodologies to assess TM/CAM and were worried that their health‑oriented paradigm would be scrutinized through an allopathic, disease‑oriented perspective, a preoccupation that we in the subluxation‑based community also share. The WHO staff was very open minded to those concerns. But eventually, all discussions fell back into allopathic thinking when they recommended that all claims made by TM/CAM should be substantiated according to the level of evidence supporting them. And of course, those levels of evidence are the ones accepted into western science with systematic reviews and meta‑analysis at the top and "tradition" (empirical experience) at the bottom. Paradigms clashing again!

Networking and relationships

More than anything else, this type of meeting gives us an opportunity to meet a lot of people with important positions in their health care system. I took this opportunity to meet as many people as possible, introducing them to the WCA, our vision and objectives, and understanding of chiropractic. In some instances, they had already been exposed to the WFC and I had to clarify our different purposes.

The WCA's goal will be to continue collaborating with and assisting the WHO staff in understanding our wellness, subluxation‑oriented view of chiropractic. It is very important that they understand the differences in paradigms within the chiropractic profession, the difference between adjustment and manipulation, as well as the issues of indications, contraindications and safety.