Today, we as a profession are desperately trying to find our niche in the health care field. It has been suggested by many chiropractic leaders that we seek and gain a respectable place within the healing arts to fit the medical model, not restricting our practice to the spine and, even more limiting, the low back.
I find it so incredibly provocative that we as chiropractors utilize the spine as our avenue of approach. That is what chiropractic is. From the inception of our profession, DCs have adjusted the spinal segments to assist the body to recover from literally hundreds of conditions which had nothing to do with back pain. In fact, one must be reminded that the chiropractic profession "began" with the treatment of a vertebral subluxation which affected the hearing of its so-called first patient.
What I find so very interesting is the medical practitioner and treating patients with a pharmaceutical which enters the body through the mouth or, in the case of an injection, through possibly the gluteal muscle. Why then are these practitioners not referred to as "mouth" doctors, or better yet, "butt" doctors?
Why is it since our avenue of approach is via the spine, we are referred to and are becoming accepted as back doctors?
Yes, we do in fact effectively treat musculoskeletal conditions, and low back pain is certainly one of the major ills of mankind which we are effective in treating, but this is just the tip of the iceberg as to what we are really all about.
Last year when the New England Journal of Medicine published the results of earlier research, the medical profession was shocked when it learned that billions of dollars were pouring into the office of "alternative" health practitioners, and collectively more dollars were spent out of pocket than were spent inside the so-called "medical establishment." It was a rude wake-up call to medicine that the people of America were "sick and tired of being sick and tired" and in the spirit of what made this country "this country," were taking matters into their own hands by seeking out those practitioners who were able to help their ills other than with drugs and surgery.
As I lecture around the world, I see a very disturbing scene which is not developing but has already developed within the educational process of chiropractic. Within the last several years, what appears to be disseminated through the chiropractic educational system is the goal of chiropractic to treat "low back pain." This is very unfortunate as research has found the public at large is eager to seek alternative practitioners for their overall health needs.
Those of you disagreeing with that last statement should have been at a seminar I presented one year ago in an American city when making reference to our history and mentioning Harvey Lillard, a 7th trimester chiropractic student asked in front of the class, "Who is Harvey Lillard?" Those of you who were present will no doubt never forget that question. The DCs in the room who had practiced for some years were literally dumbfounded as I was. It took considerable convincing to educate her that chiropractic care could possibly treat more than musculoskeletal conditions. I do not think I was truly effective in convincing this student. This happens all the time.
In the meantime, since we are fast losing our rightful place in the American health scene, there is always going to be someone there to pick up what we have haphazardly discarded. In this case it is the acupuncturists.
There are currently a total of 30 states which have enacted legislation regulating the practice of acupuncture to those individuals who have graduated from the approximately 40 colleges of acupuncture in the United States. More states are soon to join the ranks of the legislatively approved lists of acupuncturists.
Compare this with the 16 states which allow for acupuncture within the chiropractic profession, 12 of which require a specific postgraduate hour requirement to be able to practice acupuncture. Only four states have enacted rules which allow DCs to practice acupuncture as a part of their scope of practice. Of the MDs, only two states disallow acupuncture.
Of course almost every state allows for "meridian therapy" for the chiropractic profession, which is the noninvasive stimulation of acupoints. One state however, New Jersey, has made it a crime for a DC to stimulate any acupoint in any way, including simple pressure or electronic stimulation. In fact, ultrasound is highly questionable if one is using it over a grouping of acupoints. Where was the New Jersey Board of Chiropractic Examiners when this ludicrous rule was enacted? Nice move folks.
As more and more of the American populace seeks the services of those who can help with their ills and the chiropractic profession pulls further and further away to help meet those overall needs, the ranks of the acupuncture practitioner escalates every year.
Please bear in mind, these practitioners are state board approved practitioners who fall within the jurisdiction of the Board of Medical Examiners or within a state approved board of examiners specifically designed to license acupuncture within a particular state.
Just to give you a basic idea, let's take the law of two states, one on the East coast, and one on the West coast. The definition of the state of Massachussets: "Acupuncture, the practice of medicine based on traditional oriental medical theories; primarily the insertion of metal needles through the skin at certain points on the body, with or without the use of herbs, with or without the application of electric current and with or without the application of heat to the needles, skin or both, in an attempt to relieve pain or improve body function. Electroacupuncture, whether utilizing electrodes on the surface of the skin or current applied to inserted needles, and laser acupuncture are considered the practice of acupuncture.
"The rules include gwa-sha, acupatches, herbal poultices, ion cord devices, massage, reflexology, shiatsu, tui-na, ryodoraku, kirlian, photography, thermography, German electro-acupuncture, breathing exercises, oriental nutritional counseling, nonprescription substances which meet FDA guidelines, therapeutic exercises and lifestyle, behavioral and stress counseling."
I feel the need to point out tui-na as mentioned in the above definition of the law, is manipulation which when combined with "massage" as taught and practiced from the oriental viewpoint, can be considered chiropractic.
I would further like to point out the Mercy Conference, established for the well being of the chiropractic profession, has ruled that ryodoraku (which is a vital part of acupuncture) be disallowed for DCs. Again, nice move folks.
Moving west to Oregon, the definition of the acupuncture law states (a): "Acupuncture, means an oriental health care practice used to promote health and to treat neurological, organic or functional disorders by the stimulation of specific points on the surface of the body by the insertion of needles. Acupuncture includes the treatment of moxibustion, as well as the use of electrical, thermal, mechanical or magnetic devices, with or without needles, to stimulate acupuncture points and acupuncture meridians and to induce acupuncture anesthesia or analgesia. (b): The practice of acupuncture also includes the following modalities as authorized by the Board of Medical Examiners for the State of Oregon: (A) Traditional and modern techniques of diagnosis and evaluation: (B) oriental massage, exercise and related therapeutic methods and (C) the use of oriental pharmacopoeia, vitamins, minerals and dietary advice."
It is clear to see, with item (B) in the Oregon law, the chiropractic profession may definitely be facing a major dilemma as this new profession takes over traditional chiropractic practices slowly and insidiously (maybe not so slowly).
Every chiropractic leader in the country, not to mention every practicing DC, needs to be vitally aware of what is happening all around us. Our profession has failed to see what may very well be the number one threat to our very existence and that is to be replaced.
Don't think I'm paranoid. The numbers speak for themselves.
In the April 22, 1994 issue of Dynamic Chiropractic, the chiropractic population was shown on page 3, which is the history of this publication. Allow me to share what "DC" reported as practicing chiropractors for various states and to point out the corresponding number of board certified acupuncturists in their respective states. I think the numbers will enthrall you.
| State | Chiropractors | Acupuncturists | % of Acup. to DCs |
| Alaska | 121 | 12 | 9.91 |
| California | 9156 | 3664 | 40 |
| Colorado | 964 | 115 | 11.9 |
| Washington, DC | 25 | 42 | 168 |
| Florida | 3170 | 399 | 12.6 |
| Hawaii | 219 | 270 | 123 |
| Maine | 197 | 39 | 19.8 |
| Maryland | 367 | 259 | 70 |
| Massachusetts | 891 | 398 | 44.7 |
| New Mexico | 299 | 270 | 90.3 |
| New York | 3565 | 300 | 8.41 |
| Oregon | 857 | 168 | 19.6 |
| Pennsylvania | 2250 | 105 | 4.6 |
| Rhode Island | 110 | 24 | 21.8 |
| Washington | 1237 | 144 | 11.6 |
| Wisconsin | 1124 | 99 | 8.8 |
Should you have the nerve to study over the numbers of just these 15 select states, plus the District of Columbia, not to mention the remaining 35 states, I think you can clearly see that the numbers of board certified acupuncturists are fast approaching and in some cases have surpassed the numbers of DCs in some states.
The American public accepted chiropractic in its infancy because it was quick, effective, inexpensive, and often produced miraculous results. This is exactly the same reason why acupuncture is growing at such an unprecedented rate. Could we say acupuncture has replaced chiropractic in its mission at the current time?
When was the last time you heard the least bit negative response in the media regarding acupuncture? It is very rare if it exists at all.
What is the solution? The chiropractic profession needs to include the practice of acupuncture within its scope of practice in all states with educational requirements being mandatory. Chiropractic practitioners need to be aware of the mechanism of acupuncture and how to apply it even on the noninvasive scale which is acceptable in most states. Realize that it seems to be human nature within the healing arts to become incredibly greedy which ultimately will destroy or weaken a profession's influence.
Acupuncturists will no doubt become greedy, begin to fight within themselves, suffer association and organizational problems, and will weaken their position as a result. They will no doubt have major arguments over philosophy, technique, scope of practice, and may ultimately destroy themselves.
In the meantime, let's all put our all into researching friction massage, myofascial release, soft tissue manipulation, manual trigger point therapy and all of the other techniques which by state law are now part of the acupuncturists domain. Guess what? We missed the boat. The good part is it's still in sight.
Can we regain our rightful place in the healing arts? The answer to that question relies on our national and state leaders. It is so easy to say the answer lies in each and every one of us individually. If you are in a position to influence your state board members to wake up and smell the coffee, then maybe we will be in the position we should have been in years ago.
Low backs are fine but we have far too much to offer than to be replaced by another profession.
Now is the time to become proficient in acupuncture therapeutics. Remember, acupuncture is a principle, not a technique, it may be practiced in a variety of ways which by way of current definition of most states allows for the practice of meridian therapy.
Currently, there are seven CCE approved chiropractic colleges which teach acupuncture at the elective and postgraduate level. If your alma mater has closed its eyes to this natural healing art which is compatible with chiropractic and which was mentioned by D.D. Palmer in The Chiropractic Adjuster (1910), then do what you can to inspire your school to add this work to its curricula. To do so may just be one of the things necessary to change our current state of affairs.
John A. Amaro, DC, FIACA, Dipl.Ac.
Carefree, Arizona
Click here for previous articles by John Amaro, LAc, DC, Dipl. Ac.(NCCAOM), Dipl.Med.Ac.(IAMA).