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Comments on the ICA's Report to the White House Commission
Stephen Barrett, M.D.
on Complementary and Alternative Medicine Policy
The International Chiropractors
Association (ICA), which is the second largest chiropractic
organization, has submitted a 44-page report titled "Chiropractic
Science and Practice in the United States" to the White House Commission Complementary
and Alternative Medicine Policy.
The commission was established through an executive
order issued in March 2000 by President Clinton. Its purpose
was to gather information and issue recommendations about the
education and training of practitioners; research into practices
and products; provision of reliable information to the public;
and access to "complementary and alternative" care.
The ICA's report, dated February 14, 2001, states that it "focuses
on the unique nature of chiropractic as a profession because of
the need to fully understand the separate and distinct nature
of chiropractic science and practice." This "separate
and distinct" nature is embodied in the following passages
taken from various parts of the document:
- The basic premise of chiropractic science is that abnormalities
and misalignments of the spine, defined as subluxation(s) in
chiropractic science, can and do distort and interrupt the normal
function of the nervous system and may create serious negative
health consequences. The correction and/or reduction of subluxation(s)
through the adjustment of spinal structures can remove nervous
system interference and restore the optimal function of the body.
- Behavior such as physical and emotional stress, tension,
chemical/environmental stress or repetitive motion, over-extension
of spinal tissues and/or characteristics such as posture, weight,
or even footwear can establish patterns of progressive subluxation
that lead to the degeneration of spinal segments.
- Subluxation(s) have been demonstrated to be present in persons
of all ages, from the newborn infant to the most senior citizen.
- Subluxation is a progressive condition and it is therefore
in the patients' essential interest to have subluxation addressed
through the chiropractic adjustment at the earliest moment. Delay
in receiving chiropractic care can result in increasingly severe
subluxation dysfunction and require an extended period of chiropractic
procedures to correct, proportionally prolonged according to
duration of the period of neglect.
- Such early detection and intervention to address emerging
subluxation patterns is basic, essential patient care, and is
addressed at the routine checkup and prevention visit. When the
objective indicators of subluxation show the presence of a defined
spinal lesion, the doctor of chiropractic is alerted to the specific
anatomical and physiological basis for chiropractic intervention.
- Periodic chiropractic examinations to determine objectively
the presence of subluxation(s) are in the patient's interest,
and are called routine checkups and prevention visits. This is
often referred to as maintenance or wellness care. The frequency
of the need for such examinations must be determined on the basis
of individual evaluation. Such periodic examinations are a vital
component of quality basic health care. In the absence of subjective
patient complaints of specific symptoms, the doctor of chiropractic
must focus on objective measures and fully educate the patient
on the status of their condition, and the measures to be taken
to achieve optimal health.
- Only the doctor of chiropractic is professionally competent
to evaluate the chiropractic needs of a patient and to determine
the level of service appropriate to meet those needs. Chiropractic
intervention is indicated in all instances where the objective
and/or subjective presence of subluxation can be demonstrated
and/or in a setting of routine checkups. Patient needs must be
individually determined on the basis of recognized procedures,
but the issue of clinical necessity of providing adjustive care
shall be based on the presence of subluxation, and/or other structural
mis-articulations, which may or may not have yet manifested subjective
- Subluxation is a responsible and credible diagnosis for the
doctor of chiropractic and this condition should be recognized
and reimbursed as a primary diagnosis by all third-party payment
organizations, both public and private.
- Chiropractic perceives the correction of subluxation at the
earliest possible moment as the most basic, essential responsibility
of the doctor of chiropractic. The adjustment of the subluxation(s)
determined to be present is held by the chiropractic profession
to be the unique, fundamental intervention chiropractic has to
In other words, everyone's health is threatened by spinal problems,
which (a) may not have any symptoms, (b) can only be detected
by chiropractors, (c) should be searched for and corrected periodically
from birth onward, (d) and should be covered by insurance policies.
These above passages illustrate why most physicians, physical
therapists, and insurance officials have a low opinion of the
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This article was posted on March 12,