EDITORS PERSPECTIVE
Unity Through Tolerance
Matthew McCoy B.S., D.C.1
Editor in Chief
__________________________________________________________________________________________
The test of courage comes when we are in the minority. The
test of tolerance comes when we are in the majority.
Ralph W. Sockman
__________________________________________________
The Congress of Chiropractic State Associations has recently
“demanded” a merger between the American Chiropractic
Association and the International Chiropractic Association.
Even a cursory review of our profession’s history reveals prior
attempts to create “unity” in the profession through the
development of a mongrel organization. The last major
attempt was in the late 1980’s and watching the ensuing battle
was my first exposure into the venomous politics of a
profession that purports to be holistic, nurturing and centered
on well being. If the actions of the profession speak louder
than words then we are surely screaming at the top of our
lungs about how dysfunctional and dis-eased we are as a
collective mass.
Some have reflected on the profession’s immaturity to explain
all manner of internal and external strife that befalls us. From
the lack of even a semblance of a research base and
infrastructure, to our accreditation, licensing, and scope of
practice battles - to the declining market penetration and
shrinking college enrollments – piece after piece of evidence
points to an immature, whining and conflicted profession.
Some have described it as an adolescent, though I would
backpedal a little and argue for prepubescent - if not younger.
In some quarters of the profession this yearning for unity and
for us all to “just get along” is a metaphor for a young child’s
desire to see her parents remain together despite irreconcilable
differences. If the child had its way the parents would be
forced to stay together since she just can’t bear the thought of
them being apart. That COCSA is “demanding” a merger
speaks volumes about just such a metaphor.
While I believe the childlike yearning for us to all just get
along is one aspect of this cyclical push for merger and unity I
also believe there is a deeper and much more suspect
motivation for such action. We can see glimpses of this in the
demand from COCSA. One notices that COCSA does not take
a holistic view of a need for healing between the various
factions of the profession (in fact, COCSA specifically ignores
all but two factions in their merger demand but more on that
shortly) and instead there is a distinct focus on the bottom line
– money.
If you read COCSA’s demand for merging the two
associations you will see it all boils down to a fear of national
health care, whether we will be included and what the
reimbursement rates will be. The belief is we need a strategy
to ensure chiropractic’s inclusion in a national health care
scheme and one of the tactics is the profession speaking with
one voice to legislatures. Again, one can’t help but notice a
complete lack of reference by COCSA of the need for healing
of the 100 + years of internal bickering over what really
divides us.
This seems strange to me since if the decline in third party
reimbursement is what COCSA is really concerned about it
seems its energies would be better directed toward a couple of
the chiropractic managed care behemoths that have chiseled
chiropractic necessity down to 6-8 visits for acute
uncomplicated neck pain, back pain or headaches. After all,
two of these groups combined control the chiropractic benefit
of nearly all of the major insurance carriers in the country.
Even those chiropractors who are in their networks when
given the chance to comment on them cannot help but spew
words of derision usually reserved only when speaking of the
devil. It seems clear that chiropractic organizations have been
rendered impotent by these MCO’s with the worst part being
that the only reason for their thriving is because chiropractors
willingly sign contracts to be in their networks by the tens of
thousands. And if you look closely you will find that many of
the leadership on the state and national level are members of
these networks themselves. All this while they are trying to
convince the rank and file that merger is the solution to these
types of problems or pretending that they are going to sue
them and win. If there is one thing chiropractors will donate
buckets of money to – it’s a lawsuit. Get us in a room together,
tell a bleary eyed story, wait until the first tear streams down
from a face in the first row and then tell ‘em to get out their
checkbook and you’ll save them. Works every time.
_________________________________________________
1. Editor – Journal of Vertebral Subluxation Research
[email protected]
J. Vertebral Subluxation Res. May 10, 2007
Tolerance
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I know many reading this might have already concluded that I
am against such a proposed merger. Nothing could be farther
from the truth. What I am against is the motivation behind this
merger. If it was intended to heal the profession, bring us
closer, make us stronger and allow us to help more people I
might be more interested. But that’s not what it’s about. It’s
partly about selfishness, money, control and domination. Its
everywhere you look in the chiropractic profession these days.
The systematic and widespread abortion of the culture of
chiropractic that temporarily defined the profession during the
late 1800’s and early 1900’s. Chiropractic is being taken over
by an extremist wing that is seizing on the apathy of all
chiropractors and on the additional naiveté inherent in the
conservative faction of the profession.
At its beginning, fascists were particularly leery of the French
Revolution and its social theories and slogans such as: Liberty,
Equality and Fraternity.
Liberty from oppressive government
intervention in the daily lives of its citizens,
from illicit searches and seizures, from
enforced religious values, from intimidation
and arrest for dissenters; and liberty to cast a
vote in a system in which the majority ruled
but the minority retained certain inalienable
rights.
Equality in the sense of civic equality,
egalitarianism, the notion that while people
differ, they all should stand equal in the eyes
of the law.
Fraternity in the sense of the brotherhood of
mankind. That all women and men, the old
and the young, the infirm and the healthy,
the rich and the poor, share a spark of
humanity that must be cherished on a level
above that of the law, and that binds us all
together in a manner that continuously reaffirms and celebrates life.1
We see the reflection of this behavior in the chiropractic
profession on an increasing basis and the conservative
movement in chiropractic should take lessons from the
Liberty, Equality and Fraternity slogans of the French
Revolution.
Liberty is needed from oppressive intervention by those
regulatory boards controlled by the faction of chiropractic that
wishes to abandon the original premises of the profession.
Liberty is needed from regulatory boards who abuse their
power and taxpayer money by squandering state resources to
further their political agenda by singling out, punishing and
making examples out of individual chiropractors. Liberty is
needed from the enforcement of the philosophical values of
the controlling class of chiropractors. Liberty is needed from
intimidation and threat of sanction for dissenters.
Equality in the sense that while chiropractors differ in
philosophy and the application of its art we should all be
considered safe if practicing a narrow scope and not forced to
Tolerance
practice to the fullest extent of any scope. Equality in the
sense that no faction of the chiropractic profession has
exploited science to the extent that anyone can say they have
the answers to what applications are best suited for
chiropractic.
Fraternity in the sense that we all share a common ancestry in
this profession and no single person or group can claim
ownership of it. The principles the profession were based on
do not belong to us – they belong to the sick and suffering and
those wanting a better life. Our fraternity is only as strong as
our dedication to preserving those principles and being trusted
stewards to advance them. COCSA ignoring the other factions
of this profession in their call for merger are directly related to
this issue of fraternity.
If you look closely enough you can find evidence of the
destruction of these values scattered throughout the
profession. Their destruction is commingled with a lack of
consistent political principle behind the chiropractic ruling
power’s ideology because they are practicing political
opportunism in its most basic sense. They are willing to
abandon any principle to adopt an issue more in vogue and
more likely to gain converts.
No where is the evidence for my assertions more vivid than in
the transcripts of the Petition for Renewal of Recognition of
the CCE by the United States Department of Education Office
of Post Secondary Education National Advisory Committee on
Institutional Quality and Integrity.2 And my point should not
be taken as an indictment of the CCE. The point in fact is that
a careful reading of the transcripts reveals the bickering and
adolescent pettiness of a once great profession. A profession
that withstood the harshness of the early 1900’s, the jailing of
its practitioners because they challenged medicine, the fight
for licensure, academic legitimacy, insurance equality and
some semblance of social acceptance. The transcripts reveal
the shame of a profession that was given a sacred trust to
guard well and instead has molested its own offspring. And
those not directly involved are no less guilty if they sit idly by,
watching, and doing nothing to stop it. From the transcripts:
DR. DeNARDIS: Madam Chair, we've
heard charges and countercharges from I
trust a wide, fairly wide spectrum of the
chiropractic profession. At least that's the
way it seems to me. Battles over turf, battles
over philosophy, maybe battles over
personal ambition, but divisions of every
kind. And some 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,
not unusual. There are several other
professions that we deal with that have a
virtual cartel control of the profession. We
can't change that, but we can consider
measures that will try to send a message to
the prevailing control group that they should
try to be more inclusive rather than less
inclusive and I suggest that we try to figure
out what is within our range of alternatives
J. Vertebral Subluxation Res. May 10, 2007
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to do that. Because I believe if we simply
hear it, discuss it, anguish over it, and then
give them five years of recognition, that we
haven't been the impetus for any corrective
action for the profession and I worry about
the profession.
The real question is on the table: Will the prevailing and
controlling groups in the chiropractic profession put aside
battles over turf, battles over philosophy, battles over personal
ambition, and divisions of every kind and try to be more
tolerant and inclusive? This answer determines the survival of
the entire profession – not whether or not we merge.
Steps were taken a few years ago with the establishment of the
National Chiropractic Leadership Forum (NCLF) to have all
chiropractic organizations work together. The NCLF had
participation from the following organizations/groups:
American Chiropractic Association
Association of Chiropractic Colleges
Council on Chiropractic Guidelines and Practice Parameters
Council on Chiropractic Practice
Congress of Chiropractic State Associations
Foundation for Chiropractic Education and Research
International Chiropractors’ Association
National Board of Chiropractic Examiners
World Chiropractic Alliance
ChiroCode Institute
Dynamic Chiropractic
Foot Levelers, Inc.
Leander/Leader International
Federation of Chiropractic Licensing Boards
Federation of Straight Chiropractors and Organizations
National Association of Chiropractic Attorneys
NCMIC
Palmer University of Chiropractic
Parker College of Chiropractic
World Federation of Chiropractic
The NCLF had several meetings, developed a vision, guiding
principles, goals, and code of conduct. According to COCSA:
Since it’s inception in November 1998, NCLF
has developed a formal structure, has adopted
a shared vision, and has established working
groups to oversee projects aimed at attaining
agreed upon goals.3
So, considering the widespread involvement of so many
diverse organizations and the fact that they all agreed on a
vision, goals, principles and even a code of conduct – what
happened?
You can read for yourself what happened in the popular
chiropractic press where you will of course hear both sides.
No matter the interpretation of events the fact remains that the
ACA decided to no longer participate following a
disagreement over the VA Advisory Committee. So the
NCLF has not met since 2002.
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In addition to the opportunity to work in a unified manner on
common goals through the NCLF, there is also the opportunity
to work together through the Chiropractic Coalition. The
Coalition was formed by the Federation of Straight
Chiropractic Organizations (FSCO), World Chiropractic
Alliance (WCA), and the International Chiropractors
Association (ICA). It includes several state organizations as
well. The Coalition has extended an invitation to the ACA on
more than one occasion to work together on issues where there
are shared concerns. The ACA has demurred.
If COCSA is really serious about unity then they should
attempt to revive the NCLF and encourage the ACA to work
with the Coalition on shared areas of concern. Otherwise their
motives are going to be questioned since these two venues are
the only real shot at combined efforts and a united front on
significant issues. They both provide a forum to discuss
opposing viewpoints as well.
You have to ask yourself that given what happened relative to
the NCLF what would happen if there were only one national
chiropractic association and a deeply serious issue like the VA
came up – how would dissenting opinions be handled?
Truth be told, the majority of the 2000 or so of us who
currently belong to the ICA more likely than not represent the
diehards and would never vote for merger with the ACA. In
order for such a merger to happen there would need to be a
mass of ACA members joining the ICA just to vote on the
merger issue. Then even if they were to get the 2/3 majority
needed, the diehards who don’t want a merger would either
start another organization or join one of the others that closely
resemble the ICA right after the takeover. One begins to see
the silliness inherent in any effort exerted at merger.
Besides demanding merger for the wrong reasons some also
assert that if there were one national organization then more of
the disenfranchised chiropractors who right now do not belong
to any national organization would start joining if there were
only one. I’d love to see the evidence for that or hear a good
rationale for it.
If the need for merger is to present a united front for more
favorable insurance reimbursement then why isn’t the
membership of the ACA greater than 6,400? Clearly the ACA
has positioned themselves as the champion of all things third
party. Does anyone really believe that if the ICA and ACA
merge creating a collective of 8000 chiropractors that this will
suddenly encourage the other 60,000 chiropractors to join
something? I hardly think so.
Chiropractors don’t belong to associations for many reasons.
Historically, chiropractors have not been joiners and this is
mirrored by a similar trend in the greater culture. Secondly,
chiropractors know that chiropractic associations have not
been effective in accomplishing the one thing they say they
are effective at – increasing reimbursement and access. Other
than that, what do associations really do for chiropractors?
Respond to disparaging newspaper or magazine articles?
Send out press releases about back pack and gardening safety?
They don’t belong to associations because most chiropractors
are mired in a daily struggle of getting new patients, keeping
J. Vertebral Subluxation Res. May 10, 2007
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the ones they have, trying to cover their overhead and pay off
their bloated student loans. They are in survival mode. If one
recalls Maslow’s Heirarchy of Needs we can see that the
average practitioner is stuck in the lower levels of survival and
safety. The chiropractor is so mired in this personal struggle to
make it through one more day that they cannot focus on work
needed to reach the higher levels of self actualization. These
limitations on the individual chiropractor are reflected in the
profession as a whole.
And what about those that are successful in the profession. We
certainly do have them don’t we? Those in the profession that
are able to pull themselves up above 200-250 visits a week
and actually get paid for those visits are for the most part
rugged individualists and keep so focused on maintaining their
status quo that they give little attention to the questions of
whether or not the profession will survive beyond their tenure
on earth.
collective decision, then so be it and lets begin the formal split
instead of a merger. After all wouldn’t that be the adult thing
to do?
References:
1.
2.
3.
Bertlet C. What is Fascism? NLG Civil Liberties
Committee. Sept. 27, 1992.
United States Department of Education Office of Post
Secondary Education National Advisory Committee
on Institutional Quality and Integrity. The Council on
Chiropractic Education, Commission on
Accreditation Action for Consideration: Petition for
Renewal of Recognition. Tuesday, June 6, 2006.
Arlington, Virginia.
http://www.cocsa.org/pubs/forums/90_280_1201.cfm
While some of the leadership in this profession recognize this,
everyone just ignores it as chiropractic’s dirty little secret.
Those in positions within the profession to do something about
it won’t openly talk about it because typically they are
involved in the development, marketing and distribution of
products or services that needs a profession to sell to. If the
profession openly acknowledges the harsh reality that market
share is down, student enrollment is down, and that we have
little proof of our effectiveness to offer an increasingly
skeptical public – than potential students might not consider a
career as a chiropractor. Less students equals less practitioners
and less practitioners equals a smaller market for chiropractic
goods and services. We are caught in a vicious cycle.
The refusal by the leadership in the profession to address the
dysfunction and the illness we are mired in is in itself
unhealthy – we are in denial. For a profession founded on
improving homeostasis, removing interference to full
expression, holism, personal responsibility and altruism it is
quite shocking to see how we treat each other and how we
ignore any real solution. Perhaps it is the public’s perception
that we don’t really practice what we preach that adds to our
collective problem with market share.
Any real solution to this profession’s woes and ultimately for
its survival has to focus first on the basics. We need some
outside help since care providers are notorious for thinking we
can fix ourselves. We can’t. We need to look at our internal
relationships and make some serious decisions. Despite what
some might want to believe there are real differences that
divide this profession. Continuing to ignore those differences
and continuing to go along with mandates by small minorities
that happen to have all the marbles right now serves no one.
We need to face the reality that the profession is not just
divided – it is splintered. Think of rotten wood and how it’s
held together. That’s our profession. If we really want to get
along, have unity, merge or have any other semblance of that
fairly tale yearning come true then we have real emotional
work to do as a profession. We need some in depth and long
term therapy. If everyone is willing to do that – great, we
should set about doing it. If we are not willing to do that then
we are left with rotten wood, demands to get along, continued
threats and intolerance. That’s no way to live and if that is our
Tolerance
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