June 2007

Unity through tolerance

by Dr. Matthew McCoy

The Congress of Chiropractic State Associations recently "demanded" a merger between the American Chiropractic Association (ACA) and International Chiropractic Association (ICA).

Even a cursory review of our profession's history reveals prior attempts to create "unity" in the profession through the development of a mongrel organization. The last major attempt was in the late 1980s and watching the ensuing battle was my first exposure into the venomous politics of a profession that purports to be holistic, nurturing and centered on well being. If the actions of the profession speak louder than words then we are surely screaming at the top of our lungs about how dysfunctional and dis‑eased we are as a collective mass.

Some have reflected on the profession's immaturity to explain all manner of internal and external strife that befalls us. From the lack of even a semblance of a research base and infrastructure, to our accreditation, licensing, and scope of practice battles, to the declining market penetration and shrinking college enrollments ‑‑ piece after piece of evidence points to an immature, whining and conflicted profession.

Some have described it as an adolescent, though I would backpedal a little and argue for prepubescent (if not younger.) In some quarters of the profession, this yearning for unity and for us all to "just get along" is a metaphor for a young child's desire to see her parents remain together despite irreconcilable differences. If the child had its way, the parents would be forced to stay together since she just can't bear the thought of them being apart. That COCSA is "demanding" a merger speaks volumes about just such a metaphor.

While I believe the childlike yearning for us to all just get along is one aspect of this cyclical push for merger and unity I also believe there is a deeper and much more suspect motivation for such action. We can see glimpses of this in the demand from COCSA. One notices that COCSA does not take a holistic view of a need for healing between the various factions of the profession (in fact, COCSA specifically ignores all but two factions in their merger demand but more on that shortly) and instead there is a distinct focus on the bottom line ‑‑ money.

If you read COCSA's demand for merging the two associations you will see it all boils down to a fear of national health care, whether we will be included and what the reimbursement rates will be. The belief is we need a strategy to ensure chiropractic's inclusion in a national health care scheme and one of the tactics is the profession speaking with one voice to legislatures. Again, one can't help but notice a complete lack of reference by COCSA of the need for healing of the 100 + years of internal bickering over what really divides us.

This seems strange to me since if the decline in third party reimbursement is what COCSA is really concerned about, its energies would be better directed toward a couple of the chiropractic managed care behemoths that have chiseled chiropractic necessity down to 6‑8 visits for acute uncomplicated neck pain, back pain or headaches.

After all, two of these groups combined control the chiropractic benefit of nearly all of the major insurance carriers in the country. Even those chiropractors who are in their networks when given the chance to comment on them cannot help but spew words of derision usually reserved only when speaking of the devil. It seems clear that chiropractic organizations have been rendered impotent by these MCOs with the worst part being that the only reason for their thriving is because chiropractors willingly sign contracts to be in their networks by the tens of thousands.

And if you look closely you will find that many of the leadership on the state and national level are members of these networks themselves. All this while they are trying to convince the rank and file that merger is the solution to these types of problems or pretending that they are going to sue them and win. If there is one thing chiropractors will donate buckets of money to ‑‑ it's a lawsuit. Get us in a room together, tell a bleary eyed story, wait until the first tear streams down from a face in the first row and then tell 'em to get out their checkbook and you'll save them. Works every time.

The motivation behind merger

I know many reading this might have already concluded that I am against such a proposed merger. Nothing could be farther from the truth. What I am against is the motivation behind this merger. If it was intended to heal the profession, bring us closer, make us stronger and allow us to help more people I might be more interested. But that's not what it's about. It's partly about selfishness, money, control and domination. Its everywhere you look in the chiropractic profession these days. The systematic and widespread abortion of the culture of chiropractic that temporarily defined the profession during the late 1800s and early 1900s. Chiropractic is being taken over by an extremist wing that is seizing on the apathy of all chiropractors and on the additional naivete inherent in the conservative faction of the profession.

At its beginning, fascists were particularly leery of the French Revolution and its social theories and slogans such as: Liberty, Equality and Fraternity.

"Liberty from oppressive government intervention in the daily lives of its citizens, from illicit searches and seizures, from enforced religious values, from intimidation and arrest for dissenters; and liberty to cast a vote in a system in which the majority ruled but the minority retained certain inalienable rights.

"Equality in the sense of civic equality, egalitarianism, the notion that while people differ, they all should stand equal in the eyes of the law.

"Fraternity in the sense of the brotherhood of mankind. That all women and men, the old and the young, the infirm and the healthy, the rich and the poor, share a spark of humanity that must be cherished on a level above that of the law, and that binds us all together in a manner that continuously re‑affirms and celebrates life."(1)

We see the reflection of this behavior in the chiropractic profession on an increasing basis and the conservative movement in chiropractic should take lessons from the Liberty, Equality and Fraternity slogans of the French Revolution.

Liberty is needed from oppressive intervention by those regulatory boards controlled by the faction of chiropractic that wishes to abandon the original premises of the profession. Liberty is needed from regulatory boards who abuse their power and taxpayer money by squandering state resources to further their political agenda by singling out, punishing and making examples out of individual chiropractors. Liberty is needed from the enforcement of the philosophical values of the controlling class of chiropractors. Liberty is needed from intimidation and threat of sanction for dissenters.

Equality in the sense that while chiropractors differ in philosophy and the application of its art we should all be considered safe if practicing a narrow scope and not forced to practice to the fullest extent of any scope. Equality in the sense that no faction of the chiropractic profession has exploited science to the extent that anyone can say they have the answers to what applications are best suited for chiropractic.

Fraternity in the sense that we all share a common ancestry in this profession and no single person or group can claim ownership of it. The principles the profession were based on do not belong to us ‑‑ they belong to the sick and suffering and those wanting a better life. Our fraternity is only as strong as our dedication to preserving those principles and being trusted stewards to advance them. COCSA ignoring the other factions of this profession in their call for merger are directly related to this issue of fraternity.

If you look closely enough you can find evidence of the destruction of these values scattered throughout the profession. Their destruction is commingled with a lack of consistent political principle behind the chiropractic ruling power's ideology because they are practicing political opportunism in its most basic sense. They are willing to abandon any principle to adopt an issue more in vogue and more likely to gain converts.

Managing the controlling groups

No where is the evidence for my assertions more vivid than in the transcripts of the Petition for Renewal of Recognition of the CCE by the United States Department of Education Office of Post Secondary Education National Advisory Committee on Institutional Quality and Integrity.(2)

And my point should not be taken as an indictment of the CCE. The point in fact is that a careful reading of the transcripts reveals the bickering and adolescent pettiness of a once great profession. A profession that withstood the harshness of the early 1900s, the jailing of its practitioners because they challenged medicine, the fight for licensure, academic legitimacy, insurance equality and some semblance of social acceptance.

The transcripts reveal the shame of a profession that was given a sacred trust to guard well and instead has molested its own offspring. And those not directly involved are no less guilty if they sit idly by, watching, and doing nothing to stop it. From the transcripts:

DR. DeNARDIS: Madam Chair, we've heard charges and countercharges from I trust a wide, fairly wide spectrum of the chiropractic profession. At least that's the way it seems to me. Battles over turf, battles over philosophy, maybe battles over personal ambition, but divisions of every kind. And some of this, maybe most of it, is a consequence of, at least as I see it, a monopoly control of a profession which has led to the establishment of a virtual cartel, not unusual.

There are several other professions that we deal with that have a virtual cartel control of the profession. We can't change that, but we can consider measures that will try to send a message to the prevailing control group that they should try to be more inclusive rather than less inclusive and I suggest that we try to figure out what is within our range of alternatives to do that. Because I believe if we simply hear it, discuss it, anguish over it, and then give them five years of recognition, that we haven't been the impetus for any corrective action for the profession and I worry about the profession.

The real question is on the table: Will the prevailing and controlling groups in the chiropractic profession put aside battles over turf, battles over philosophy, battles over personal ambition, and divisions of every kind and try to be more tolerant and inclusive? This answer determines the survival of the entire profession ‑‑ not whether or not we merge.

Steps were taken a few years ago with the establishment of the National Chiropractic Leadership Forum (NCLF) to have all chiropractic organizations work together. The NCLF had participation from the following organizations/groups:

* American Chiropractic Association

* Association of Chiropractic Colleges

* Council on Chiropractic Guidelines and Practice Parameters

* Council on Chiropractic Practice

* Congress of Chiropractic State Associations

* Foundation for Chiropractic Education and Research

* International Chiropractors' Association

* National Board of Chiropractic Examiners

* World Chiropractic Alliance

* ChiroCode Institute

* Dynamic Chiropractic

* Foot Levelers, Inc.

* Leander/Leader International

* Federation of Chiropractic Licensing Boards

* Federation of Straight Chiropractors and Organizations

* National Association of Chiropractic Attorneys

* NCMIC

* Palmer University of Chiropractic

* Parker College of Chiropractic

* World Federation of Chiropractic

The NCLF had several meetings, developed a vision, guiding principles, goals, and code of conduct. According to COCSA:

"Since it's inception in November 1998, NCLF has developed a formal structure, has adopted a shared vision, and has established working groups to oversee projects aimed at attaining agreed upon goals." (3)

So, considering the widespread involvement of so many diverse organizations and the fact that they all agreed on a vision, goals, principles and even a code of conduct ‑‑ what happened?

You can read for yourself what happened in the popular chiropractic press where you will of course hear both sides. No matter the interpretation of events the fact remains that the ACA decided to no longer participate following a disagreement over the VA Advisory Committee. So the NCLF has not met since 2002.

In addition to the opportunity to work in a unified manner on common goals through the NCLF, there is also the opportunity to work together through the Chiropractic Coalition. The Coalition was formed by the Federation of Straight Chiropractic Organizations (FSCO), World Chiropractic Alliance (WCA), and the International Chiropractors Association (ICA). It includes several state organizations as well. The Coalition has extended an invitation to the ACA on more than one occasion to work together on issues where there are shared concerns. The ACA has demurred.

Revive the NCLF

If COCSA is really serious about unity then they should attempt to revive the NCLF and encourage the ACA to work with the Coalition on shared areas of concern. Otherwise their motives are going to be questioned since these two venues are the only real shot at combined efforts and a united front on significant issues. They both provide a forum to discuss opposing viewpoints as well.

You have to ask yourself that given what happened relative to the NCLF what would happen if there were only one national chiropractic association and a deeply serious issue like the VA came up ‑‑ how would dissenting opinions be handled?

Truth be told, the majority of the 2000 or so of us who currently belong to the ICA more likely than not represent the diehards and would never vote for merger with the ACA. In order for such a merger to happen there would need to be a mass of ACA members joining the ICA just to vote on the merger issue. Then even if they were to get the 2/3 majority needed, the diehards who don't want a merger would either start another organization or join one of the others that closely resemble the ICA right after the takeover. One begins to see the silliness inherent in any effort exerted at merger.

Besides demanding merger for the wrong reasons some also assert that if there were one national organization then more of the disenfranchised chiropractors who right now do not belong to any national organization would start joining if there were only one. I'd love to see the evidence for that or hear a good rationale for it.

If the need for merger is to present a united front for more favorable insurance reimbursement then why isn't the membership of the ACA greater than 6,400? Clearly the ACA has positioned themselves as the champion of all things third party. Does anyone really believe that if the ICA and ACA merge creating a collective of 8000 chiropractors that this will suddenly encourage the other 60,000 chiropractors to join something? I hardly think so.

Chiropractors don't belong to associations for many reasons. Historically, chiropractors have not been joiners and this is mirrored by a similar trend in the greater culture. Secondly, chiropractors know that chiropractic associations have not been effective in accomplishing the one thing they say they are effective at ‑‑ increasing reimbursement and access. Other than that, what do associations really do for chiropractors? Respond to disparaging newspaper or magazine articles? Send out press releases about back pack and gardening safety?

They don't belong to associations because most chiropractors are mired in a daily struggle of getting new patients, keeping the ones they have, trying to cover their overhead and pay off their bloated student loans. They are in survival mode. If one recalls Maslow's Hierarchy of Needs we can see that the average practitioner is stuck in the lower levels of survival and safety. The chiropractor is so mired in this personal struggle to make it through one more day that they cannot focus on work needed to reach the higher levels of self actualization. These limitations on the individual chiropractor are reflected in the profession as a whole.

And what about those that are successful in the profession. We certainly do have them don't we? Those in the profession that are able to pull themselves up above 200‑250 visits a week and actually get paid for those visits are for the most part rugged individualists and keep so focused on maintaining their status quo that they give little attention to the questions of whether or not the profession will survive beyond their tenure on earth.

While some of the leadership in this profession recognize this, everyone just ignores it as chiropractic's dirty little secret. Those in positions within the profession to do something about it won't openly talk about it because typically they are involved in the development, marketing and distribution of products or services that need a profession to sell to. If the profession openly acknowledges the harsh reality that market share is down, student enrollment is down, and that we have little proof of our effectiveness to offer an increasingly skeptical public ‑‑ than potential students might not consider a career as a chiropractor. Less students equals less practitioners and less practitioners equals a smaller market for chiropractic goods and services. We are caught in a vicious cycle.

The refusal by the leadership in the profession to address the dysfunction and the illness we are mired in is in itself unhealthy ‑‑ we are in denial. For a profession founded on improving homeostasis, removing interference to full expression, holism, personal responsibility and altruism it is quite shocking to see how we treat each other and how we ignore any real solution. Perhaps it is the public's perception that we don't really practice what we preach that adds to our collective problem with market share.

Any real solution to this profession's woes and ultimately for its survival has to focus first on the basics. We need some outside help since care providers are notorious for thinking we can fix ourselves. We can't. We need to look at our internal relationships and make some serious decisions. Despite what some might want to believe there are real differences that divide this profession. Continuing to ignore those differences and continuing to go along with mandates by small minorities that happen to have all the marbles right now serves no one.

We need to face the reality that the profession is not just divided ‑‑ it is splintered. Think of rotten wood and how it's held together. That's our profession. If we really want to get along, have unity, merge or have any other semblance of that fairly tale yearning come true then we have real emotional work to do as a profession. We need some in depth and long term therapy. If everyone is willing to do that ‑‑ great, we should set about doing it. If we are not willing to do that then we are left with rotten wood, demands to get along, continued threats and intolerance. That's no way to live and if that is our collective decision, then so be it and lets begin the formal split instead of a merger. After all wouldn't that be the adult thing to do?

References

1. Bertlet C. What is Fascism? NLG Civil Liberties Committee. Sept. 27, 1992.

2. United States Department of Education Office of Post Secondary Education National Advisory Committee on Institutional Quality and Integrity. The Council on Chiropractic Education, Commission on Accreditation Action for Consideration: Petition for Renewal of Recognition. Tuesday, June 6, 2006. Arlington, Virginia.

3. www.cocsa.org/pubs/forums/90_280_1201.cfm

(Dr. Matthew McCoy is one of the founding members of the Council on Chiropractic Practice and has been instrumental in the development of the profession's most widely accepted set of chiropractic guidelines. He's also editor of the Journal of Vertebral Subluxation Research and has extensive practice, research and educational experience. He gained international acclaim when he helped introduce chiropractic to the Russian medical community by developing a chiropractic spine treatment, teaching & research center in Vladivostok, Russia. He is currently the Director of Research at Life University. Dr. McCoy is vice‑president of RCS, serves as a member of the WCA Board of Directors, chairs the WCA Chiropractic Advocacy Council and was a liaison member of the National Academy of Sciences and Institute of Medicine's Committee on Alternative Medicine. He can be contacted via e‑mail at editor@jvsr.com)