Serious consideration must be given to how acupuncture and/or naturopathy degree programs can be put into place without adversely affecting the practice rights of licensed chiropractors. Consideration should also be given to not unduly burdening practicing chiropractors and future students with excessive tuition costs, should they wish to join in the potentially expanding scope of practice afforded by these developments. I will look into this and related issues.
The AMA and its cohorts have played a shell game. In the mid-19th century, AMA members were called allopathic or regular practitioners; at the turn of the 20th century, they started calling themselves scientific practitioners; by the 1920s the title had become just medical practice. This left other schools of medical practice having to add some other word to describe their schools of medicine: homeopathic; eclectic; chiropractic; naturopathic; traditional Chinese medicine; etc. The Association of American Medical Colleges in a January 13, 1998 memorandum acknowledged that "mainstream medicine" is "allopathy," which they defined as "to oppose disease."
Medicine
As the allopaths have captured the use of the word "medicine," and others have to now add some descriptive adjective to distinguish themselves, a broader, more nonspecific term is preferable. The contest should be over substance, not merely words. We have been hung up long enough on "that's not chiropractic," or naturopathy, or whatever. MDs don't fight about what "medicine" means. They focus on substance. Let's allow some early icons of chiropractic and natural health care to weigh in:
DD Palmer - "Disease is but the performance of functions in either an excessive or deficient amount. All disease shortens life by deteriorating the quality of the tissue . . ."1
BJ Palmer - "We are prone to observe two gross classifications:
- Functional 'dis-eases' where we cannot observe abnormal matter.
- Pathological 'dis-eases' where we do observe abnormal matter. The borderline between, to our observed so-called trained senses, is obscure, concealed and beclouded. We think of 'nervous diseases' as of function minus pathological structural destruction of tissue...."2
John Howard,DC (founder, NCC) "Our system is as broad as nature itself, and therefore embraces all natural methods which possess virtue in assisting normal function of the body. The term 'physiological adjustment' speaks for itself: correction of body function by physiological means."3
Terrence Bennett,DC - "The healing arts professions have far too long neglected the clinical phenomenon of abnormal physiology (abnormal function) in the preoccupation with what was considered to be disease entities and pathology involving tissue changes."4
The common concept is functional medicine. Acupuncture is also functional medicine. When traditional Chinese practitioners refer to the heart meridian, they are not referring to an anatomical structure, they are referring to a functional unit. Functional medicine is a broad concept. In my view, the term functional medicine serves several important purposes:
- The term is sufficiently nonspecific to allow growth and refinement based upon new findings in science. (To repeat, we should debate the science rather than the meaning of words such as "chiropractic" or "naturopathy.")
- The term functional medicine has historical precedent.
- The concept of functional medicine can serve to distinguish practitioners within this paradigm from "medical" practitioners.
- Functional medicine is an "alternative bio-medical paradigm." (It includes prevention, early intervention and "wellness.")
- The concept of the innate "regulatory matrix" addressed in the previous articles in this series is the primary basis of functional medicine as practiced in Germany.
We should borrow a page from the allopath's "strategy" book. They do not create a new license category (or new degree) every time they develop a new diagnostic tool or therapeutic process. They simply incorporate the tool/process into the nonspecific term "medicine." The allopathic monopoly is, however, served when alternative medicine is broken into pieces. Then, the allopaths can reduce "alternative medicine" to merely "alternative therapies" and seize control over such.
Divide and Conquer
The founder of Dynamic Chiropractic, Donald Petersen,DC, is quoted in Assault on Medical Freedom as having a high opinion of its author - P. Joseph Lisa. I have quoted this book in numerous articles. A central point of that book is that after the "quackbusters" lost the Wilk, et al., case, they developed a new strategy, the gist of which is:
- "Divide and conquer by specialization."5
- Restrict the scope of practice of chiropractors to neuromusculoskeletal problems.6
- Have insurance carriers deny any chiropractic claims related to the use of meridian therapy, acupuncture, and similar types of treatment, including nutrition, etc.7
A subtle, but very important point must be made. The strategy of "divide and conquer" is directed toward creating multiple licenses (and perhaps accreditation structures) more than multiple degrees or multiple specialties within any particular degree or license. It is the splintering of the practice rights that gives mainstream medicine the edge. The practice rights of mainstream medicine are said to be "unrestricted" or "unlimited." Any dividing up or limiting of the practice rights of others serves to strengthen its position. Again, alternative practitioners should borrow a page from mainstream medicine.
MDs/DOs - One License
Many states in the U.S. allow "unlimited practice rights" to persons with either the MD or the DO degree. Certainly that is true in California and Illinois. In California that was accomplished by a "treaty" between MDs and DOs, and ultimately, litigation. In Illinois it was achieved by the Chicago College of Osteopathy v. Puffer (1955) decision. The court basically ruled that because osteopathic education (and accreditation) matched that required for the unlimited-license-granted MDs, it would constitute undue discrimination to refuse DOs the same, "unrestricted" practice rights available to MDs. Prior to Puffer, DOs in Illinois had been classified as "drugless physicians" with DCs.
DC, ND, DDT Degrees
In part two of this series I discussed John Howard's early connections with German naturopathy. Through most of the time, from its founding in 1906 to 1952, NCC offered the DC degree and also the ND or DDT (doctor of drugless therapy) degrees. A separate licensing structure was not created. No additional license was needed because DCs in Illinois were, and still are, already broadly defined by law as "drugless physicians."
From 1922 to the early 1950s, the presidents of all the schools that merged into LACC held both the DC and ND degree; 17 of 18 other administrators held both degrees; and 19 out of 27 full- time faculty members held both degrees. (LACC is now called Southern California University of Health Science. I will, with apology, refer to it here as LACC for purposes of recognition.) What happened in the early 1950s to change all this?
- The era of the so-called "wonder drugs" had recently arrived.
- The AMA worked hand-in-glove with the FDA, state medical boards, and agencies (such as the attorney generals around the country) to eliminate naturopathic practitioners. They achieved their objective, and laws permitting the practice of naturopathy were repealed in almost all states by the late 1950s and early 1960s.8
- But most importantly, the "death-dealing blow to the profession of naturopathy"9 was the prohibition by what is now the Council on Chiropractic Education (CCE) against chiropractic colleges teaching natural methods of treating the sick (except spinal manipulation). This edict was issued in 1952.
The 1952 CCE edict was ironic. From the early 1900s to the 1940s, the typical chiropractic degree program required the completion of about 2,000-2,500 hours. That meant that the additional ND or DDT degrees could be added onto the 2,000-2,500-hour requirement. However, in the late 1940s, the requirements for the DC degree were generally increased as, for example, in California, where the prescribed curriculum was increased from 2,400 hours to 4,000 hours in 1948. Having eliminated natural healing courses such as herbs; glandulars; homeopathics; neurovascular and visceral "manipulation," etc., what was put in its place? The curriculum became, and remains, oriented to mainstream diagnostic and treatment procedures. The chiropractic scope of practice, however, precludes chiropractors from using much of what they have learned. It is time to put the natural healing concepts back into the chiropractic curriculum.
But How?
The basic question is, "Should the proposed natural healing curriculum (such as "regulatory matrix" evaluation and "adjustment;" herbs; glandulars; acupuncture; homeopathics; visceral manipulation; etc., as I've described in previous articles) be electives within the 4,800-hour chiropractic curriculum, or added onto it. Obviously, it is significantly different to add hours to a 2,000 to 2,500-hour curriculum, as was the case prior to the 1950s, rather than to a 4,800-hour curriculum, as is now required to obtain the chiropractic degree. Let's look at some numbers.
Curriculum and Fees
In 1990, the University of Bridgeport (UB) opened its school of chiropractic. In 1997, it opened a separate school of naturopathic medicine, and is contemplating opening a school or program of acupuncture and traditional Chinese medicine. UB is seeking accreditation of its naturopathic program by the national accrediting agency for naturopathic education.
The last time I checked (about three years ago), only one of the 11 states that licensed naturopaths required graduation from a school accredited by the national naturopathic accrediting agency. In the other states one could substitute "approval" by the state agency itself, or, in some instances, regional accreditation. The Puffer case, cited earlier as an example of how DOs leveled the playing field with MDs, is instructive here. There is no need for requiring duplicate accreditation so long as the same standards are met. Why should 60,000 chiropractors go knocking on the doors of about 2,000 "accredited" naturopaths for their approval of our educational process? You tell me!
If you are a chiropractor, even if you just graduated from UB and want the naturopathic scope of practice, you will have to go back to school for approximately two years, or 2,000 hours. The same holds true if you would like to obtain the ND degree from Bastyr College of Naturopthic Medicine. ("Bastyr" is named after John Bastyr,DC,ND.)
Now to the tuition numbers. I will assume that a 4,800-hour chiropractic education costs about $100,000, or approximately $2,000 per 100-hour segment. I will assume the same $2,000 in tuition fees per 100-hour segment of naturopathic or acupuncture (traditional Chinese medicine - TCM) education.
Chiropractic education, pursuant to the edict of the CCE, requires completion of approximately 4,800 hours, but the typical accredited naturopathic program is only about 4,000 hours. What's the tuition cost, assuming that the hours in natural healing courses are added on to the curriculum rather than being electives within the basic 4,800 hours?
| DC degree | 4,800 hours | $96,000 |
| ND plus | 2,000 hours | $40,000 |
| total | 6,800 hours | $136,000 |
I will now use California as the basis for a comparison. The California Chiropractic Act requires only 4,000 hours for the DC degree and requires 600 hours of electives. This elective requirement has been totally ignored. Let's call the 4,000-minus-600 hours the "core curriculum." That means that if one were to still complete 4,800 hours, there would be 1,400 elective hours available for study in both the theoretical and clinical application of herbs; homeopathy; glandulars; visceral manipulation; "regulatory matrix" evaluation and adjustment, etc.
| Core Curriculum | 3,400 hours | $68,000 |
| Added Hours | 1,400 hours | $28,000 |
| total | 4,800 hours | $96,000 |
Of course, there would be significant overlap in the 1,400 hours and much of it should entail clinic practice.
Grandfathering: What about existing chiropractors? As indicated, much of the 1,400 hours would duplicate what is already in place, with perhaps some changes in focus; in addition, much of it would be "clinic." Practicing chiropractors are already gaining clinical experience in their own offices, and one could get even more creative and provide for further clinical enhancement with internet connections between several practitioners, and between them and the schools - even clinicians around the world - a sort of "internet clinic rounds." Due to space constraints, I will not address credit that should be given for "diplomate" course work previously completed.
Inspection of approved acupuncture programs shows that they typically offer about 200 to 300 hours of actual acupuncture coursework and, at least in California, the Acupuncture Act prescribes 300 hours coursework in herbal practice. In addition, many states presently require chiropractors, MDs, dentists and podiatrists to complete 60 to 300 hours in acupuncture to be certified. That is why, for example, NCC offers 100 to 300 hours in acupuncture certification coursework.
Therefore, it seems highly likely that existing chiropractors could meet contemporary standards not only for acupuncture but also for naturopathy or, my own personal preference, functional medicine within 300 to 600 hours of additional course work. Thus, rather than paying $40,000 tuition fees, as would be required under the University of Bridgeport or Bastyr approach, they would end up paying close to $6,000 to $12,000 to be qualified for a broader scope of practice, granted to separately licensed naturopaths and acupuncturists. For the 100 to 300 hours of additional work in acupuncture, the tuition would be $2,000 to $6,000, rather than over $25,000 for the additional work required to complete a separate licensing program.
California Practice Rights
I have written several articles for this publication about the scope of practice issues in California. I will not rehash all that here, but I will revisit two specific cases.
Oosterveen Case: In 1953, two naturopaths licensed outside California went to court and argued they were being deprived equal protection of the law because they could not get licensed to practice naturopathy in California. The California court disagreed, and indicated that if they wished to practice naturopathic methods of healing, they could get licensed as either an MD or DC. The court also pointed out that at that time (1953), naturopathy was practiced by over 1,200 chiropractors in California. Rule 302 is incompatible with this case, and supersedes it until that rule is challenged and changed.
Chong case: The present Rule 302 specifically provides that chiropractors may not "practice surgery or sever or penetrate tissues of human beings." Therefore, chiropractors cannot use acupuncture needles without acquiring the additional acupuncture license. The rule is simply wrong. However, to repeat, it is the law until changed.
While the California Chiropractic Act provides for at least 600 hours of electives, the state board has never prescribed the requirements for that curriculum, and the schools have never offered it. Rule 331.1.2 has since 1977 recommended that electives be offered in "meridian therapy." Why not "acupuncture?" It is because California chiropractors supposedly cannot penetrate or sever tissue.
Two of the most fundamental rules used by courts in interpreting statutes are:
- Look to the statutory and case law that preceded the statute to be interpreted; and
- Whenever wording in a statute is changed, it is deemed to be important, and to manifest and intention to actually change the substance of the prior rule.
The 1913 Medical Practice Act provided that "drugless practitioners" were prohibited from "penetrating or severing tissue."
Dr. Chong, a chiropractor, was prosecuted in 1916 for practicing medicine without a license. He argued that he was being denied due process of law because whenever he did an adjustment, authorities claimed, he "penetrated and severed tissue" and therefore he could not have practiced under the 1913 drugless practitioner license, even if he had obtained one. The court responded that the drugless practitioners were only prohibited from penetrating or severing tissue "with a knife." Penetrating tissue with a knife would mean you were doing "surgery," which was reserved to "physicians and surgeons." In my view, the Chong case triggered the change in language in the 1922 Chiropractic Act, to a prohibition against performing surgery with a knife, rather than penetrating or severing tissue. Therefore, chiropractors should have been allowed to use needles.
Attorney Michael Schroeder, in handling the California scope of practice lawsuit from 1989 to 1991, never brought the Chong case (or any law preceding 1922) to the attention of the court, and California chiropractors ended up being prohibited from penetrating or severing tissue. The present Rule 302 (adopted in 1991) has never been challenged in court. Neither LACC, nor any other California chiropractic college intervened in the case handled by Mr. Schroeder to protect its students, or graduates' scope-of-practice rights. Nor have they challenged the rule since its adoption in 1991.
The Board of Chiropractic Examiners cannot challenge its own Rule 302 because they accepted the settlement arranged by Mr. Schroeder. As a result, if you want to use acupuncture needles in California, you have to go back to school for about 1,200 hours ($24,000) and sit for an additional licensing examination. In my opinion, that could be changed by appropriate legal challenge to the existing Rule 302.
As previously indicated, the LACC has started a new and separate school of acupuncture and traditional Chinese medicine. One can only hope that Rule 302 will be changed so that it will also better serve the rights of practicing chiropractors by offering a 100-300-hour certification program in acupuncture similar to that offered by Dr. Amaro and the NCC. (UCLA has a 300-hour program in acupuncture for MDs.)
Of course, if you wanted to add herbs, etc., that would necessitate additional training. However, the expenses entailed would obviously be much less than pursuing a whole new license. Equally important is the fact that by dividing up the field of non-allopathic medical practice, we are playing into the hands of mainstream medicine.
Review and Conclusions
I began this series of articles by agreeing with Dr. Amaro that there was a "turf war" going on between chiropractors and acupuncturists. We have shown that the war is extending to naturopaths with the creation of new, separate schools of naturopathy. We have reviewed some of the evidence for the use of acupuncture needles based upon Western neurology, diagnostic criteria and the "regulatory matrix." The use of needles is obviously not within the exclusive domain of traditional Chinese medicine.
We have reasoned that license categories are not synonymous with degree titles. That is, one can qualify to be a "physician and surgeon" with either the MD or DO degree. California once defined the nonallopathic license category as drugless practitioners. Illinois still uses the term "drugless physician," an appropriate license category for practitioners under the DC, ND, OMD or other appropriate degree title. (As previously indicated, NCC at one time used "doctor of drugless therapy" as a degree title.) How the license categories are created, structured and used for education toward various degrees and specialization makes a huge difference to both the cost of acquiring rights to practice, and to the opportunity of mainstream medicine to usurp the practice rights of alternative practitioners.
For me, the real "turf war" is primarily constitutional and philosophical. What is the "ultimate ground of being?" As a former professor of constitutional law, I am committed to the leveling of the playing field (I do not mean "dominating" it) for a biomedical science based upon "holism," irreducible complexity, inherent self-regulation and the proposition that life is the product of intelligent design; that it is teleological. Allopathic, materialistic, reductionistic biological and medical science based upon "warring" with disease and nature, and an assumption that life is the product of random chance, should not have the monopolistic power it has acquired. This is a war not only for practitioners of alternative medicine, but for the very "heart and soul" of this planet. I aim to serve.
References
- Palmer DD. The Science, Art and Philosophy of Chiropractic (1910) p.25.
- Palmer BJ. The Subluxation Specific - The Adjustment Specific (reprinted 1993) p.500.
- Beideman R. In the Making of a Profession: The National College of Chiropractic 1906-1981(1995) p. 39.
- Martin. Dynamics of Correction of Abnormal Function, Terrence Bennet Lectures (privately published in 1977), p. vii.
- Lisa. supra, at p. 152.
- Id., at p. 227-228.
- Id.
- Lisa. The Assault on Medical Freedom (1994) pp. 264-281.
- Wardwell. Chiropractic, History and Evolution of a New Profession (1992) pp. 38, 141-142.
David Prescott,DC,MA,JD,FIAMA
Silverado, California