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The Council on Chiropractic Education Straightens Up?

Three years ago, we reported that the Council on Chiropractic Education (CCE) was deeply embroiled in a heated dispute among various chiropractic factions over its new accreditation standards for chiropractic colleges. In a June, 2012 update of that post, we found the CCE still deeply embroiled in a heated dispute among various chiropractic factions over new accreditation standards for chiropractic colleges. Current events, however, require that we now report that the CCE remains deeply embroiled in a heated dispute among various chiropractic factions over new accreditation standards for chiropractic colleges. And it has come to this:

CCE does not represent me

Ostensibly, the debate is about whether chiropractic students should be taught to detect and correct the putative subluxation and CCE’s commitment to chiropractic’s remaining a drug and surgery-free practice. As we have discussed several times here at SBM, a faction of chiropractors fancy themselves as primary care physicians who are competent to diagnose and treat patients with a wide variety of diseases and conditions, such as diabetes and cardiovascular disease, with various methods, such as “Functional Endocrinology.” This is, in fact, the position of the largest and most mainstream of the chiropractic trade associations, the American Chiropractic Association (ACA). (The ACA is actively promoting reimbursement of chiropractors for required primary care benefits under the Affordable Care Act.)

At the other end of the spectrum, the chiropractic purists (or “straights”) believe chiropractors should limit themselves to the detection and correction of the (non-existent) chiropractic subluxation. And they are adamant about chiropractic remaining “without drugs or surgery.”

Protestations to the contrary notwithstanding, chiropractic belief in the subluxation is widespread among chiropractors in North America and in Australia. And as far as I can tell, chiropractors who eschew belief in the subluxation have merely renamed it and redefined it in terms so vague as to be meaningless. Those who want to expand chiropractic to include a broader range of treatments do not exclude the subluxation as a relevant clinical entity. They’ve simply tarted it up in an attempt to obscure its lack of scientific viability.

The CCE on probation

The Council on Chiropractic Education, which accredits all 15 U.S. chiropractic colleges, has become a surrogate battlefield on which these skirmishes are fought. Usually chiropractors manage to stay on group message in their public persona. This unified front is facilitated by their isolation – their schools operate outside the mainstream American higher education system and their practices generally operate outside the mainstream healthcare system. No one really knows what they are up to. But because the CCE must renew its recognition as an accrediting agency with the U.S. Department of Education (Education) every three years, the public gets a peek inside.

The National Advisory Committee on Institutional Quality and Integrity (NACIQI) conducts the recognition process for Education. Its staff looks into whether an accrediting agency under review is meeting Education’s standards. The staff issues a report to the NACIQI, which, after a public hearing, makes a recommendation to Education. The straight chiropractic faction perennially uses CCE’s re-recognition by Education as an opportunity to harp on the CCE’s move (as seen by the straights) away from traditional chiropractic toward the “medicalization” of the practice. Because, in the straight’s view, the more liberal end of the chiropractic spectrum controls the CCE for its own purposes, the CCE is unrepresentative of the entire profession and the schools teaching traditional chiropractic philosophy. And this view has received some sympathy from at least one NACIQI member, who said in a 2006 hearing on the CCE’s continued recognition:

[S]ome 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.”

This led the dissidents henceforth to refer to the chiropractic powers that be as “The Cartel.” When CCE came up for recognition renewal again, in 2011, battle lines were drawn.

NACIQI received about 4,000 letters on the subject, only 30 of which were positive. At a December, 2011, hearing, in addition to staff and CCE representatives, 25 others who represented the broad range of chiropractic practice testified (e.g., the ICA, ACA and Association of Chiropractic Colleges). Of these, representatives of 2 spoke in favor of the CCE and 23 against.

The staff report was unflattering too. It found over 40 deficiencies in applicable standards for re-recognition, which garnered CCE the dubious distinction of being in the top tier of accrediting agencies in violation of Education’s standards. According to The Chronicle of Chiropractic (“The Source for News on Traditional, Conservative Chiropractic”):

Arthur J. Rothkopf, president emeritus of Lafayette College and vice chairman of NACIQI told CCE, “You’ve hit the jackpot on deficiencies,” noting that the problems enumerated by the department suggest a “sloppiness” in CCEs actions as an accreditor.

(To give you an idea of where The Chronicle is coming from, it carries an ad seeking support for the “National Vaccine Information [Mis] Information Center.” So, if you ever need proof that chiropractors are anti-vaccination, here’s your citation.)

The NACIQI recommended a one-year extension of the CCE’s recognition so they could clean up their act. In addition, the NACIQI imposed a requirement that the CCE become more representative of the entire profession. This delighted the protesters. While the Undersecretary of Education agreed with NACIQI on all other points, it said the Department had no authority to impose this additional requirement. The CCE was to issue a full report in one year, at which time there would be another staff evaluation and hearing. The Undersecretary warned the CCE that further extensions were rare and that it could lose accreditation if CCE didn’t straighten up. Later, another hearing before the NACIQI was set for December 12-13, 2013. (That is, starting today.)

The dissenters circle their prey

The CCE thus weakened in the eyes of the straights, they set to work. They formed their own coalition of organizations named the “Da Vinci Group,” ironic in light of Leonardo Da Vinci’s meticulous study of anatomy. According to one member, the International Chiropractic Pediatrics Association (ICPA), the Group is a coalition of “at least” 70 chiropractic organizations. The most robust of these is the International Chiropractors Association (ICA), the official trade association for the straight faction, which provided funding to form the Group and emerged as a natural leader for the organization, an involvement that led to later disappointments, as we shall see.

The Group is now circulating a petition:

To be meaningful, CCE reform must include, but not be limited to the following elements:

1) Vertebral subluxation detection and reduction, stated in unambiguous terms, in both symptomatic and asymptomatic patients must be included in the CCE Standards as the essential element in a curriculum leading to the Doctor of Chiropractic degree.

2) Chiropractic must be defined as “without drugs and surgery” in the Standards. [“Drugs” means OTC as well as prescription drugs.]

3) Governance reform of the CCE including: [briefly, reforms in elections and an expansion of site teams which inspect schools for the CCE].

Note the “in both symptomatic and asymptomatic patients” language. In other words, the Group is demanding that students be taught “maintenance care,” sometimes referred to as “wellness care.” This is based on the chiropractic philosophy that all patients, including newborns, suffer from subluxations throughout their lives. If not reduced by adjustments (or manipulation, a term they use interchangeably with adjustment) these subluxations interfere with the nervous system’s regulation of the body, resulting in health problems, including heart disease, sudden infant death syndrome, allergies, asthma – you name it.

While the Da Vinci Group didn’t want to see the CCE killed as the recognized accrediting agency, it did want to put it on life support for one more year while Education decided whether to pull the plug for good. The Da Vinci Group members would argue to the NACIQI that if CCE were re-accredited, it should only be for another year, either by extension of its probation or a shortened recognition time. During that time, the Group could use CCE’s tenuous grip on life to leverage its own position.

A defection to the Cartel

Things were going along swimmingly when, in November of this year, ICA broke ranks as a result of an offer during the November meeting of yet another chiropractic group, The Summit. The Summit apparently consists of some groups (the CCE, the ACA, etc.) the dissidents would refer to as the Cartel, but the ICA is also a member. (Other professions have subgroups based on specialty, e.g., the American Academy of Pediatrics, the America Bar Association Section of Anti-Trust Law. Chiropractic apparently groups itself according to factions.)

At that meeting, the Summit decided it would endorse continued recognition of the CCE and issued a statement saying so. In what appears to be an attempt to soothe, or at least quiet, the dissenters, the statement said:

After multiple focus groups, the following marketing language was passed: The Summit acknowledges the concepts of spinal health and well-being as credible marketing messages and we encourage further efforts to refine and test such efforts.

Which is an interesting thing to say smack dab in the middle of a document explaining a group’s position on the governance of the chiropractic educational system. Perhaps it inadvertently reveals something about the focus of chiropractic education.

Relevant to charges that the CCE and other chiropractic organizations were being wishy-washy about drugs:

no chiropractic organization in the Summit promotes the inclusion of prescription drug rights and all chiropractic organizations in the Summit support the drug-free approach to health care.

So now we have yet another subdivision of chiropractic. A sub-faction of the mixers, the DC as PCP group, wants the privilege of prescribing drugs, although they are not generally the type of drugs any medical doctor would ever think about using on patients. They’ve achieved some success in New Mexico but were rebuffed in Colorado. And now they’ve been rejected by the Summit, although maybe “multiple focus groups” could change the Summit’s mind if prescription drugs become a “credible marketing message.”

The CCE, in front of all the other Summit members at the meeting, offered to engage in good-faith discussions addressing the ICA’s (as well as some other Summit member’s) concerns about CCE’s governance. The ICA president also “spoke with” the CCE leadership about including the Da Vinci Group in these conversations. In exchange, the ICA would temper its testimony against CCE at the December NACIQI hearing, not oppose re-recognition, and not limit its support of recognition to one year.

The Group regroups

The rest of the DaVinci Group was not amused. (One headline in the chiropractic press read: “ICA Endorses CCE . . . Move Shocks DaVinci.”) Accusations went flying. Chiropractic had managed to split into yet another set of factions. The Group viewed ICA’s action as joining The Cartel for sure. Claims and counter-claims were made about the effect of the CCE’s loss of accreditation status on federal student loans (a big cash cow for chiropractic colleges) and state licensing (many states defer to the CCE accreditation in deciding whether to accept a degree from a particular chiropractic college in determining eligibility to practice).

The ICPA sent out a urgent “Call to Action” e-mail to members bemoaning the CCE Standards’ “ambiguous” language on the subluxation and lack of a clear stance against drugs and surgery. It asks, rhetorically:

Do you want the freedom to effectively care for your patients, to proficiently adjust spines of all ages and offer the best possible chiropractic care too all: symptomatic or not? Do you desire research that substantiates the role of the adjustment in wellness and improved quality of life?

Yes, after all, what is the goal of research other than to tell you you’re doing everything exactly right?

In the midst of all this, the DaVinci Group suffered another blow when the NACIQI staff report was released in advance of the current hearing. Staff found that CCE had indeed straightened up. Staff recommends renewal of CCE’s recognition for a period of three years. All parties appear to be in agreement that NACIQI will adopt the recommendation and CCE’s recognition is assured.

If you are looking for some insight into chiropractic education from this 45-page report, forget it. To me, it reaffirms the notion that schools teaching black magic could form the Council on Black Magic Education accrediting agency and get that agency approved by the U.S. Department of Education as long it complied with financial, conflict of interest and like standards. It doesn’t matter WHAT you teach. Once again, the staff blew off complaints about the subluxation’s supposedly dwindling role and the “medicalization” of chiropractic education. But the dissidents remain undeterred.

So what? Who cares?

If you want to judge chiropractic education, look at chiropractic practice. As noted at the beginning of this post, practice is still mired in the subluxation, whether the original or new, murkier, multi-name version. Best I can tell, what has been added to practice in the name of “progress” are silly tests for “nutritional deficiencies,” homeopathy, claims that chiropractors are primary care physicians, acupuncture, and other treatments which lack a grounding in science. Frankly, I don’t care who wins this fight, or all the sub-fights within the main event. For me, their value is in providing a rare public glimpse into what transpires in the world of chiropractic.

What I do care about is the fact that millions of patients are spending millions of dollars on worthless diagnoses and treatments at the hands of chiropractors. The federal government’s approval of the CCE only serves to facilitate this unconscionable state of affairs. And it makes the taxpayer foot part of the bill, in the form of student loans. All in all, a terrible waste of money that could be going to improve healthcare in a meaningful way.

Posted in: Chiropractic, Legal, Politics and Regulation

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