March 2005

WHO develops chiropractic training, safety guidelines

A special report by World Chiropractic Alliance International Board of Governors Asher Nadler, DC and Yannick Pauli, DC

For several years, the World Health Organization (WHO) has been working on a strategy to facilitate the integration of traditional and complementary/alternative medicines into the national health system of its Member States as well as to promote the proper use by consumers of those traditional and complementary approaches.

Because chiropractic is now practiced worldwide in more than 100 countries, it is among the first professions that WHO looked at in its process of guidelines development.

The WHO Consultation on Chiropractic that took place on December 2‑4, 2004 in Milan, Italy is the result of several years of cooperative work between the WHO and chiropractic organizations, such as the World Chiropractic Alliance (WCA).

At the invitation of the WHO, chiropractic experts from around the world met to discuss the final draft of the "WHO Guidelines on Basic Training and Safety in Chiropractic." Those guidelines, due to be released in early 2005, have three major objectives:

***  To provide minimum requirement for chiropractic education

***  To serve as reference for national authorities in the establishment of systems for the education and licensing for the qualified practice of chiropractic

***  To review contraindications and ensure the safe practice of chiropractic.

The Guidelines are the culminating point of a process that involved the participation of 167 chiropractic experts in 53 countries, 54 national health authorities in 37 countries and 52 international and regional chiropractic organizations.

Representing the WCA were Dr. Asher Nadler, a member of the WCA International Board of Governors and president of Israel Doctors of Chiropractic and Dr. Yannick Pauli, a member of the WCA International Board of Governors and WCA liaison to the WHO.

Also in attendance were 30 other experts from various fields.

Representing chiropractic were: David Chapman‑Smith, secretary‑general of the World Federation of Chiropractic (WFC); Dr. Anthony Metcalf, WFC president; Dr. Martin Camara from the Philippines; Dr. Ricardo Fujikawa, WFC council member for Latin America; Dr. Ed Lee from Hong Kong; Dr. Jean‑Pierre Meersseman from Italy; Dr. Koichi Nakagaki from Japan; Dr. Jonh Sweany from Australia; Dr. Jean Moss, president of the Association of Chiropractic Colleges; Dr. Peter Dixon, past president of the European Chiropractors Union; and Dr. Anfinn Kilvaer, past president of the European Council on Chiropractic Education. The rest of the participants included three osteopaths, one medical doctor specializing in manual medicine and representatives of national health authorities.

The meeting was sponsored by the Government of Lombardy, Italy and led by Dr. Xiaorui Zhang, coordinator of the Traditional Medicine department of the WHO.

Minimal requirements for chiropractic education

Most of the meeting was spent discussing minimal requirements for chiropractic education. This issue is not so obvious for countries where the practice of chiropractic is regulated by law. It is, however, of utmost importance for countries where no chiropractic legislations yet exist.

There are examples of countries where medical groups have organized "chiropractic training" in short courses of 200 hours or less. In other countries, practitioners are calling themselves chiropractors although they do not have formal chiropractic training. This is the case in Japan where 10,000 practitioners originating from the local bone setting tradition practice some form of manual therapy, calling themselves "chiropractors."

The new guidelines now clarify the issue by recommending minimal requirements for the qualified practice of chiropractic. For example, they make it clear that a graduate from medical school will require a minimum of 1,800 hours, with no less than 1,000 hours of clinical experience.

Representing wellness‑oriented, subluxation‑based chiropractic

The WCA has been in relationship with the WHO for several years, more particularly with Dr. Zhang and her staff. Because many of the experts selected were WFC officers or affiliated with the WFC, the presence of WCA representatives was essential in insuring that the voice of chiropractors practicing wellness‑oriented, subluxation‑based chiropractic be heard.

The presence of the WCA has insured that references to vertebral subluxation are included in the document. For example, the guidelines stipulate that chiropractic graduate must "achieve a fundamental knowledge of health sciences, with a particular emphasis on those related to vertebral subluxation and /or to the neuromusculoskeletal system." Subluxation and Vertebral Subluxation Complex are both defined in the glossary of the document.

Although in minority, the WCA was able to insure that it was made clear that the chiropractic profession places a particular focus on the subluxation and that chiropractic adjustments are used to influence neuro‑physiological function and, as such, are different from joint or spinal manipulation.

In that context, the document refers to contraindication to spinal or joint manipulation, and not to chiropractic specific adjustment. Whereas a medical condition of the spine may contraindicate the delivery of a spinal manipulation, it does not necessarily do so for the delivery of a chiropractic adjustment, such as those used, for example, in low force techniques.

The guidelines also explain that chiropractic is not a technique, but a profession. Although adjustments ‑‑ and for some chiropractors other manual approaches ‑‑ are central to chiropractic care, the latter also include patient education, exercise and other health‑promoting strategies.

The World Chiropractic Alliance is proud to have participated in such an important project and will continue its cooperative effort with the WHO on international chiropractic issues.