August 2004

WHO keeps chiropractic, osteopathic guidelines separate

 by Dr. Yannick Pauli, World Chiropractic Alliance International Board of Governors

"Manual therapy" is one of the most popularly used form of Traditional Medicine /Complementary and Alternative Medicine (TM/CAM), but many countries have not yet established education, proper training programmes or examination and licensing systems for practice.

In order to promote the qualified practice of TM/CAM ‑‑ and consumer safety ‑‑ the World Health Organization (WHO), in collaboration with non‑governmental organizations, is developing a series of basic training and safety guidelines, including manual therapies.

Since chiropractic is the most popular of those "manual therapies," the WHO has prepared a draft entitled "WHO Guidelines on basic training and safety in chiropractic." This guideline has several objectives:

**bullet** provide recommendation on the minimum requirement of basic training for someone to be allowed to call him/herself a chiropractor

*** provide information on contraindications

*** serve as a reference to national authorities (where there is as of yet no chiropractic regulations) to establish examination systems for the education and licensing of the qualified practice of chiropractic.

Although the process has been underway for a long time, recently some osteopathic organizations had informed WHO that, in their opinion, osteopathy and chiropractic were quite similar. They suggested that osteopathy should be included in the chiropractic guidelines rather than within the more general guidelines on other manual therapies.

The WHO therefore convened a meeting specifically to discuss the relationship between chiropractic and osteopathy and give recommendation as to whether the two professions should be included into one guideline or two separate ones.

Twenty people attended the meeting representing the World Chiropractic Alliance, American Academy of Osteopathy, the American Osteopathic Association, the European Chiropractor's Union, the European Council on Osteopathic Education, The General Chiropractic Council (UK), The General Osteopathic Council (UK), the New Zealand Register of Osteopath, Osteos de France, the Prince of Wale's Foundation for Integrated Health, the Registre des Osteopathes de France, and the World Federation of Chiropractic.

The WHO, under the supervision of Dr. Xiaorui Zhang, Coordinator of the Traditional Medicine Department, was interested in learning more about similarities and differences between osteopathy and chiropractic, especially as it related to techniques.

The morning session was organized into 20 minutes presentation made by the American Osteopathic Association, the World Federation of Chiropractic, the General Osteopathic Council, the World Chiropractic Alliance, and the American Academy of Osteopathy.

It became quite apparent right from the beginning that the osteopathic organizations had only a very little understanding of the process of guidelines development. They perceived the creation of the draft on chiropractic training and safety as an endorsement of chiropractic by the WHO and were worried that their profession was to be left behind. They therefore argued for the similarities, the need to work in cooperation, and for osteopathy to be included in the chiropractic guidelines.

Mr. David Chapman‑Smith, speaking on behalf of the WFC, pointed out the very different educational standards in osteopathy throughout the world. Whereas American osteopaths are medical doctors, a few of whom use osteopathic manipulative treatments, other countries have no minimal educational standards. Schooling ranges from a few thousand hours to week‑end courses. On the contrary, chiropractic has an international standard on chiropractic education.

Representing the World Chiropractic Alliance, I argued that technical similarities and differences were irrelevant to the discussion. The fact that it was argued that both professions used "spinal manipulation" is a false debate. Essence, not form, defines a profession. The clinical objective ‑‑ what it strives to accomplish ‑‑ is what defines a profession, and not the technique it uses to fulfil that objective.

Clearly, it was apparent that osteopathy had a very different essence than chiropractic. Whereas osteopathy strives to diagnose, treat and prevent human ailments ‑‑ and in the United States does so by also prescribing drugs and performing surgery ‑‑ chiropractic strives to optimise health, wellness and quality‑of‑life by facilitating the safe, effective and economical location, analysis and correction/reduction of vertebral subluxation.

Moreover, chiropractic is not a technique. It is a profession, with a distinct essence and theoretical focus, and a unique art form. The specific chiropractic adjustment that is very different from a spinal manipulation. It is evident to us that chiropractic and osteopathy are two different professions, requiring separate guidelines. We therefore argued in that direction.

The afternoon was dedicated to discussions between osteopathy and chiropractic on the technical, legal, political and educational levels. The osteopathic organizations argued at length that a minimal standard should be required to be able to deliver a spinal manipulation (bringing the joint past its normal range‑of‑many through a thrust), and since chiropractic and osteopathy were the major players, we should discuss that. It took quite some time to demonstrate that this was not the objective of the present meeting. Yet, osteopathic representatives kept bringing back that issue.

Finally, after lengthy discussions, it was decided that the process of chiropractic guidelines would go forward as such, and that guidelines specific to the osteopathic profession would be developed.

The first draft of the chiropractic guidelines has been published and will be disseminated for feedback and comments by the WHO. Once feedbacks are returned, the WHO will prepare a second draft and will circulate it again. Once all comments have been addressed, the WHO will organize a meeting with selected experts to finalize the guidelines. This process is planned to be completed by the end of 2004 or beginning of 2005.

The WCA is actively involved in every stage of the process.

(Dr. Yannick Pauli is a member of the World Chiropractic Alliance International Board of Governors and serves on the Research Committee of the Council on Chiropractic Practice, as well as its Technique Committee, representing NSA/Torque Release, and an associate editor of, and contributing author to the Journal of Vertebral Subluxation Research. In addition, Dr. Pauli is the WCA Liaison to the World Health Organization, where he actively takes part in the development of international chiropractic guidelines. He is in private practice in Switzerland.)

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