Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Wednesday, January 05, 2005

Controversy Erupts over Proposed Chiropractic College at Florida State University

Controversy Erupts over Proposed Chiropractic College at Florida State University

Samuel Homola, D.C.


In 2003, the Florida State Legislature allocated $9 million to establish a chiropractic college within Florida State University (FSU). University officials have declared that the school would be science-based and have hired Alan Adams, D.C., a former vice-president of the Southern California University of Health Sciences (formerly called the Los Angeles College of Chiropractic) to organize it. But many FSU faculty members and alumni are highly skeptical and are campaigning to stop what would be the nation's first university-based chiropractic college [1].

Adams and the administrator who hired him have indicated that they intend to start from scratch and use a science-based approach, combining a chiropractic degree with a master's degree in an established health science such as nutrition or exercise. Although this sounds promising, it's important to remember that chiropractic is based upon an implausible theory that correction of "vertebral subluxations" will improve health. Chiropractic "subluxations" have never been clearly defined or anatomically demonstrated and no evidence exists that spinal adjustments improve general health [2]. Yet in 1996, the Association of Chiropractic Colleges (ACC) issued a position statement that "Chiropractic is concerned with preservation and restoration of health and focuses particular attention on the subluxation." [3] The resultant document, commonly referred to as the ACC Paradigm, was endorsed by the International Chiropractic Association and the American Chiropractic Association in 2000 and the World Federation of Chiropractic in 2001.

To be science-based, a chiropractic school must be completely free of "subluxation" theory and its associated misbeliefs and train its students in the use of manipulation and the physical treatment modalities that are used by physical therapists. If chiropractors are to be trained as "neuromusculoskeletal specialists" who function as independent practitioners in a capacity beyond that of physical therapists, it might be necessary to include training in use of prescription medication and certain invasive diagnostic procedures. Such chiropractors would work much like physiatrists (medical doctors who specialize in physical medicine and rehabilitation), with emphasis of manipulation and physical treatment methods. Either way, there would be duplication of existing medical services. However, without a fundamental change in the nature of its chiropractic teachings, FSU would graduate "alternative" practitioners who display their university degree as evidence that subluxation-based chiropractic offers a rational approach to health care.

Unanswered Questions

A science-based chiropractic college with a new approach and a new definition of chiropractic, associated with a major university, may ultimately reduce the number of subluxation-based chiropractors, which would be a change for the better. But if this means duplication of services that could be provided by physical therapists and other health-care providers, is a new chiropractic college really necessary? Would an FSU chiropractic college duplicate the subluxation-based Palmer College of Chiropractic Florida in Port Orange, Florida, which teaches chiropractic's "Big Idea" (the notion that the body heals itself when interference to the proper functioning of the nervous system is removed)? Or would it move diametrically away from the principles of Palmer, inviting confrontation in a divided camp?

Some chiropractors do a good job treating some types of back pain, offering manipulative services not readily available in medical practice, but they work more like physical therapists than subluxation-based chiropractors who adjust or manipulate the spine to restore and maintain health [4]. At present, most state laws and chiropractic organizations define chiropractic as a method of correcting subluxations, not as a method of treating back pain. Although physical therapists manipulate or mobilize the spine as a treatment for back pain and not for correction of subluxations to remove nerve interference, chiropractic associations support efforts to prevent the use of spinal manipulation by physical therapists [5]. This has the effect of restricting appropriate use of spinal manipulation. Will FSU become mired in this squabble?

Physical therapists trained in the use of spinal manipulation, sans the subluxation theory, could fill the need for manipulative therapy without encroaching upon chiropractic dogma. At the present time, the use of manipulation/mobilization by physical therapists to relieve and prevent disability is more evidence based than the belief-driven adjustment/manipulation used by chiropractors to "restore and maintain health." Properly-limited chiropractors, who use manipulation appropriately, would welcome examination of the chiropractic theory by academia and by medical scientists. And I suspect that few science-based chiropractors would object to inclusion of spinal manipulation in the treatment methods of physical therapists, physiatrists, and other practitioners who use manual medicine. But chiropractors who cling to the subluxation theory to justify their existence as independent practitioners may resist any change in the definition of chiropractic, opposing use of spinal manipulation by anyone other than a chiropractor, even if it means perpetuating inappropriate use of such treatment. Such chiropractors point to studies indicating that spinal manipulation is effective in the treatment of some types of back pain in a misguided attempt to support adjustment of subluxations in the treatment of general health problems—mixing science and pseudoscience to sell false hope. University-trained, science-based chiropractors who practice a properly defined, limited form of chiropractic would have to split away from the majority of chiropractors who practice a traditional form of chiropractic, which often embraces such dubious practices as homeopathy and applied kinesiology.

It seems obvious to me that before opening an FSU school of chiropractic, the administration should clearly delineate the treatment methods and scope of practice that it intends to teach. A subluxation-free approach would require a new and clear definition of chiropractic. If chiropractic is not redefined, maintaining a chiropractic college as part of an accredited, science-based university may not be feasible. However, a science-based definition might cause problems for FSU graduates who want to practice in states whose laws incorporate subluxation concepts. Florida law (Statute §460.403), for example, defines the practice of "chiropractic medicine" as:


a noncombative principle and practice consisting
of the science of the adjustment, manipulation,
and treatment of the human body in which
vertebral subluxations and other malpositioned
articulations and structures that are interfering
with the normal generation, transmission, and
expression of nerve impulses between the brain,
organs and tissue cells of the body, thereby causing
disease, are adjusted, manipulated, or treated, thus
restoring the normal flow of nerve impulse which
produces normal function and consequent health
by chiropractic physicians using specific chiropractic
adjustment or manipulation techniques taught in
chiropractic colleges accredited by the Council on
Chiropractic Education. No person other than a
licensed chiropractic physician may render
chiropractic services, chiropractic adjustments, or
chiropractic manipulations.


In 1998, more than 4,000 chiropractors were licensed under this definition in the State of Florida, which ranks fourth in the nation in the number of chiropractors per state. Can the FSU chiropractic college teach a different kind of chiropractic—a science-based chiropractic—without a change in state law? If chiropractic is redefined at FSU, would an unchanged state law permit science-based graduates of FSU to practice a different kind of chiropractic in Florida? How would a new state law affect the thousands of chiropractors now practicing in the State of Florida? Would FSU chiropractors work more like physical therapists? Or would their training include use of prescription medication to allow them to function as independent neuromusculoskeletal specialists? Any reasonable change in the definition of chiropractic, requiring departure from the vertebral subluxation theory, would encroach upon the established practice of physical therapy or physical medicine. It seems likely that many chiropractors will oppose any change in the definition of chiropractic, since the subluxation theory is the basis for licensing chiropractors in most states. But I do not see how the fundamental definition of chiropractic could be tolerated in a science-based university.

I fear that a chiropractic school at a major university like FSU will attract well-meaning, highly qualified students who know little or nothing about chiropractic, unaware of the stigma associated with chiropractic and unprepared to compete with fundamentalist chiropractors or to endure the criticisms of those who oppose them. Some may realize too late that they have made a bad career choice.

I struggled through 43 years of practice as a "good chiropractor," but I cannot, in good conscience, recommend that anyone follow in my footsteps. A Ph.D. program in physical therapy that includes training in spinal manipulation might make more sense for qualified individuals.

Fully science-based chiropractors might need to have a new degree that will differentiate them from graduates of subluxation-based chiropractic colleges. For example, a Doctor of Chiropractic Therapy (D.C.T.) degree for a group-dependent therapist, or a Doctor of Chiropractic Medicine (D.C.M.) degree for an independent neuromusculoskeletal specialist, would indicate training different from that required for a standard Doctor of Chiropractic (D.C.) degree.

The Bottom Line

How chiropractic is defined and taught at FSU, and the behavior of its chiropractic school graduates, may have a profound effect on public health and reflect upon FSU's credibility as a science-based institution. Before proceeding further, all parties concerned should determine whether a chiropractic school at Florida State University is really feasible and whether graduates of such a school are needed to provide services based primarily upon use of spinal manipulation.


References

1. Bousquet S. FSU chiropractic school not a done deal just yet: The Legislature and Gov. Bush have approved the funds to create the school, but opponents are hoping to block it anyway. St. Petersburg Times, Dec 12, 2004.
2. Barrett S. Chiropractic's elusive "subluxation." Chirobase, Dec 25, 2001.
3. Chiropractic paradigm. Association of Chiropractic Colleges, 1996.
4. Homola S. What rational chiropractor can do for you. Chirobase, May 19, 1999.
5. Arkansas chiropractic board trying to stop physical therapists from manipulating. Chirobase, Sept 30, 2003.

This article was posted on December 31, 2004.




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