Movement for Chiropractic Quality and Integrity

Dedicated to Serving the Exceptional Chiropractic Experience

MCQI Public Statement at CCE Semi-Annual Meeting

MCQI appreciates the opportunity to provide public comments. We are pleased to see an effort... to solve some of the serious issues addressing chiropractic education and the rift within the profession as a whole.

While these efforts have seemed promising at times, our concerns are... that the efforts may be more of an effort to “dot the i’s and cross the t’s”... than to generate profound and meaningful changes. These current efforts appear to be designed to give the appearance... to the NACIQI and USDE Secretary... that the CCE has addressed issues raised at the last NACIQI hearing.

In order for lasting peace and collaboration to take place... sincere efforts and meaningful changes... in governance and in CCE bylaws... must be realized.

We recommend that:

Bylaws be amended to change the category of councilors and the number of councilors per category so the council represents the needs of the profession and graduates and truly represent all stakeholders views.

  1. Creating a student category with representatives from each DCP.
  2. Amendment to the bylaws... requiring the executive committee to include one representative from each category of councilor.
  3. Restructuring of the bylaws, election process and categories... to create representation based on student fees received from each DCP; thus... creating equal representation of the students’ choices in educational and paradigm preference.

We are very concerned with the latest proposed changes to the Preface of the CCE Standards. Specifically... we object to language... that clearly gives a green light, to the continued advance of a small minority of the profession, towards the expansion of the chiropractic scope and the dilution of our core identity.
Such expansion is... and would further be... a blatant infringement on other fields of practice and expertise, such as medicine. There is no need to duplicate what already exists.

While we understand the CCE’s position... that scope... is a state issue... and understand the reality of that process, it is not outside the sole chiropractic accrediting agency’s role to identify our core identity for the profession and public. An identity that the majority of profession has clearly identified in several of the most comprehensive surveys on the subject. (McDonald, Smith, World Federation of Chiropractic Identity Survey)

In fact, the WFC Identity Survey... identified that, and I quote, “positioning the profession as non-drug, non-surgical heath care is viewed as being integral to how the profession should be perceived by the general public.”

In that survey of over 3600 DCs from around the world, 78% of US respondents agreed that the chiropractic identity should remain non-drug, non-surgical. 82% of those out of practice 1-5 years felt the same way. This coming from the group most closely affected by your policy decisions. The report went on to find that... “the non-drug, non-surgical mandate of chiropractic is viewed as being ‘cornerstone’ to the profession’s identity.”

We would like to know why the CCE sees it fit to cater to such a small minority of the profession... when the majority is clearly against such an agenda to morph the very basic nature... and core values of chiropractic?

Failure of the CCE to address the basic identity, and core values of chiropractic is the very reason we find ourselves here today... and is negligent on your part... in pursuing your mission objective of: “serving as a unifying body for the chiropractic profession.
An objective that clearly has not been achieved... and in fact your actions have produced the opposite effect.

We appreciate Dr. Benberg’s recent statements regarding the allowance of Vertebral Subluxation centered programs to operate without unnecessary or biased restrictions, however, we have serious concerns regarding inconsistencies in statements coming from CCE leadership.

Specifically we are concerned with CCE Council Chair, Dr. Wickes statement to the NACIQI committee in December 2011 when he stated “The standards require that the students learn how to evaluate, understand the concepts of subluxation, how to assess for the presence of subluxation, and how to perform the vertebral adjustment to correct subluxation. That's a part of our accreditation.” Dr. Wickes confirmed the statement made by Mr. O’Bryon on behalf of the Association for Chiropractic Colleges to NACIQI: “...and all of our schools teach vertebral subluxation; that was a question, all the schools teaching chiropractic adjustments. It's part of the clinical practice skills and the competencies which they walk out the door with.”

The recent proposed changes to the Preface statement indicates subluxation and neuro- biomechanical dysfunction are synonymous. We disagree with this assessment. Neuro-biomechanical dysfunction is a vague term while subluxation is widely accepted by the majority of chiropractors (McDonald, Smith), is included in recognized practice guidelines (CCP, ICA, PCCRP, NGC), and is the only condition reimbursed by Medicare.

Because adjusting patients for vertebral subluxation(s) is the core clinical requirement of chiropractic care in the fifty states, and the only chiropractic procedure covered under our nation's Medicare program, CCE’s accreditation process must ensure that all programs prepare DC students to manage patients with spinal subluxation(s).

All major chiropractic organizations including the ACA, ICA, and WFC have accepted the Association of Chiropractic Colleges Paradigm, which adopted the following statement concerning subluxation:

"Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation. A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health. A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational
and empirical evidence.”

Considering the wide acceptance of this term by the colleges, organizations and members of the profession... we are confused as to why the CCE considers it an optional competency or one that can be replaced by terminology... that a select few... find more socially presentable... despite professional, legal and regulatory acceptance of the term.

We recommend removing the term neuro-biomechanical dysfunction and placing the word ‘vertebral’ in front of subluxation.

Furthermore, while CCE’s mandatory Meta-Competencies allow for the assessment of the presence of vertebral subluxation and require the determination of the need for chiropractic adjustment, its outcomes egregiously leave optional documentation of competence in the delivery of chiropractic adjustments (META-COMPETENCY 2 - MANAGEMENT PLAN, # 4).

We suggest that metacompetencies be added to the actual Standards to address the identification and management of vertebral subluxation and that more meaningful standards be put in place to assess the most basic, core competency of the chiropractor: The adjustment of vertebral subluxation.

Thank you for your time and attention.

References:
1. McDonald W, Durkin K, Iseman S, Pfefer M, Randall B, Smoke L, Wilson K. How chiropractors think and practice. Ada, Ohio: Institute for Social Research; 2003
2. Smith M, Carber LA. Survey of US chiropractor attitudes and behaviors about subluxation. Journal of Chiropractic Humanities, 2008;15:19-26.
3. WFC Identity Task Force
4. ACC Paradigm Statement

MCQI Public Statement at CCE Semi-Annual Meeting
http://mcqi.org/downloads/2013-01-16-mcqi-public-statement-at-cce-semi-annual-meeting.pdf

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