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).

Sunday, January 16, 2005

Why the FSU Chiropractic School Shouldn't Happen

Why the FSU Chiropractic School Shouldn't Happen

Lessons From Chiropractic History

The history of chiropractic has shown that it has a "lebensraum" mentality, in other words an expansionistic political agenda.

The way it continuously files lawsuit after lawsuit in attempts to prevent others from using spinal manipulative therapy proves this. Besides this, the inclusion of anything in the basic education or post-graduate seminars, gets used later as an excuse to expand their scope of practice. This includes intrusion into other health care profession's territory. In principle (fortunately not in fact!) its tactics remind one of the Nazi's "Lebensraum" thinking: If chiropractic is to survive, it needs to take patients from others. There is no legitimate niche available for it. This kind of competition does not reveal a spirit of cooperation or good intentions. It certainly does not create any good will.

Chiropractic organizations have always been highly vocal about "persecution" from the medical community, while at the same time hypocritically competing directly with MDs by claiming that DCs are qualified to take care of the whole family's health needs, as well as to function as "primary care" "physicians". Chiropractic has always, right from the beginning, done all it could to cause the public to lose confidence in MDs and medical science with its anti-science, anti-MD, anti-intellectual, anti-medicine, anti-surgery and anti-vaccination propaganda.

The Danish Story

Denmark has a chiropractic school affiliated with one of its universities. The Danish Society for the Promotion of Chiropractic (my translation) literally bought itself into the university (similar to the unsuccesful attempt at York, and the present attempt at FSU), and then used this as a lever to get itself included for benefits under the National Health Insurance. MDs and PTs then received letters from the Ministry of Health commanding them to cooperate with DCs.

All of this was preceded by plenty of chiropractic talk (hot air) of willingness to cooperate and be a part of the healthcare team. Anti-medical statements were rarely heard, and the atmosphere was suffiently non-antagonistic (most Danes, including MDs, know little about the history or real intentions of chiropractic) to fool the Minister of Health into giving them a change of legal status. Before about 1992-1993 they were officially covered by the Quackery Law. Now they suddenly weren't legally "quacks" anymore.

When PTs received the letters from the Ministry of Health, our local regional group contacted the local chiropractic regional group and proposed that we hold meetings, since we were now officially "partners" and we needed to get to know each other. They agreed and a Meeting Agenda was drawn up by each party. When they saw that the proposal from the PTs included topics like Definitions, Diagnoses, Methods, and Scope of Practice, they cancelled the meetings. That was about 11-12 years ago. Nothing has happened since then.

Then some of the PT organizations and groups that held seminars even began to allow chiropractors to begin to attend meetings and get certificates, but there was little or no reciprocation.

So far we have seen none of the promised cooperation. Instead they have succeeded in lobbying politicians very directly to give them more rights and freer hands. Right from the beginning they even succeeded in getting direct access, and unlimited right to start private practices. PTs don't have direct access in Denmark, and their right to start private practices is tightly controlled by the Ministry of Health. The playing field is simply uneven.

They had been doing whatever they wanted to all along as legally defined "quacks", and they succeeded in getting their way of doing things simply accepted *as it was*, including their price structure. This means that a PT can charge about one third of the price for a manipulation as a chiropractor, with no justification for the difference. A chiropractor can charge the same for a five minute treatment, as a PT can for a 35-45 minute treatment. The patient gets far more for their money from a PT!

Chiropractors also give discounts to patients who become members of the Society for the Promotion of Chiropractic, while PTs must not give discounts.

The Profession's Intentions

Keep in mind that the very clearly expressed intention of the profession (I consider the ACA president to be a representative for the entire profession) is to legally forbid *all* others from using spinal manipulation, for *all* reasons, and to reserve that right for itself, whereupon it will continue to primarily use it for *illegitimate* reasons:

The following excerpt from an ACA press release is significant. They state clearly, what is the only possible result of trying to administrate an internally inconsistent law: “bureaucratic gibberish”.

“In a supplemental motion to its November 9, 1999 briefing memo, the ACA had also referred to the HHS' contradictory statements regarding physical therapists' ability to perform spinal manipulation to correct a subluxation under Medicare as “stonewalling” and “bureaucratic gibberish”.

“The heart of the Medicare+Choice (also known as Medicare Part C) controversy centers around HCFA regulations which, in ACA's view, illegally allow Medicare managed care plans to substitute as a benefit spinal manipulation performed by medical doctors, osteopaths, physical therapists, and other providers, in lieu of spinal manipulation to correct a subluxation performed by chiropractors.....only a chiropractor is qualified to diagnose and treat a subluxation through manual manipulation of the spine.”

"ACA President James A. Mertz, DC, DACBR, said, "With the latest response from HHS, the ACA's lawsuit against the Health Care Financing Administration (HCFA) has reached a critical point. While the ACA views the decision on physical therapists as a victory in itself, our fight is certainly not over. Nobody but a doctor of chiropractic is qualified to perform manual manipulation to correct a subluxation-not a medical doctor, not an osteopath. We will continue to pursue this lawsuit until we're assured that only doctors of chiropractic are allowed to provide this service to Medicare + Choice beneficiaries." (For the APTA's reaction to this, see the corresponding Practice Policy news brief "APTA Responds: PTs Will Continue to Perform Manipulation.")"

The ACA’s *precise* and *correct* choice of wording here is critical to an understanding of their meaning and intent. They pit two very different things against each other, quote:

“...spinal manipulation performed by medical doctors, osteopaths, physical therapists, and other providers, in lieu of

spinal manipulation to correct a subluxation performed by chiropractors.”

The two purposes for manipulating, as well as the two groups who practice it, are contrasted. “Chiropractors”, with their roots in Palmer’s biotheology, using manipulation "to correct a subluxation" (fiction), are pitted against “medical doctors, osteopaths, physical therapists, and other providers”, with their roots in evidence based medicine, performing “spinal manipulation” for real problems. Which side is the law going to support? The present wording of the law is problematic.

As pointed out above, the difference lies in the “purpose” for performing the manipulation. Chiropractors wish to secure exclusive right to the use of manipulation for what is in fact a non-existent entity - the “chiropractic subluxation”. They wish to keep the legal recognition of their fantasy. At the same time, they would like to deny other providers the right to use manipulation at all.

They know that the continued allowance of manipulation by other providers, for the treatment of real, orthopedic subluxations and other conditions where manipulation may be useful, will be counterproductive to themselves. Such manipulation by others for real problems, will continually stand as a contrastful witness against the folly of manipulating a fantasy. It will undermine and weaken them in their attempts to maintain belief in this illusion. They will lose customers.

A Skeptical Position Is the Only Responsible One

What evidence do we have that they will suddenly change their MO and their publicly and officially voiced plans for the future?

I have nothing but skepticism for the current attempts at FSU to pull the wool over the eyes of the public, politicians, and school officials. All talk of reform will be history once they get their way. These new chiropractors won't be "real" chiropractors, but they will function as Trojan Horses for the rest of the illegitimate profession, with all its nonsense - which will go unchanged.

Legally Sanctioned Corruption

The result will be a form of legally sanctioned corruption, similar to the legal status of homeopathy, where a fiction is legally allowed to go unchallenged.

The lack of agreement between the intentions of the law, and what is actually going on, will be resolved, by accepting a farce as legal: "If you can't beat 'em, join 'em" situation. A lot of illegal things in society could easily be "solved" by just making them legal in this way. The illegal "misuse" of narcotics could easily be solved if the "mis" was removed from the law. Problem solved, right? Wrong!

Making a chiropractic school at FSU will solve nothing. On the contrary, it will be used as a lever to force full acceptance of chiropractic, including all of its nonsense.