My name is Dr. Terry Rondberg. I am a doctor of chiropractic and president of the World Chiropractic Alliance (WCA), 2950 N. Dobson Rd., Chandler, AZ 85224. I am also the publisher of The Chiropractic Journal, the voice of the World Chiropractic Alliance. It is a monthly publication which reaches more than 50,000 chiropractors in the United States and thousands of additional chiropractors worldwide. WCA is the only national organization which reaches all doctors of chiropractic every month with every issue.

The World Chiropractic Alliance is a non-profit organization of doctors of chiropractic, with members in every state in the United States and in numerous nations around the world. I appreciate this opportunity to submit my comments for the record of the Subcommittee.

The WCA would first like to thank the Congress for its efforts to incorporate chiropractic into the Veterans Affairs Health Services. Time and again, scientific research has shown that chiropractic can be effective in improving health and wellness in a wide range of patients. It provides a unique and drug-free service which can reduce health care costs in many instances.

In addition, by supporting direct access to chiropractic by any patient wishing such care -- without referral by a medical doctor -- Congress is protecting patients’ right to choose the health care method best suited to them and their individual health care needs.

However, the World Chiropractic Alliance is very concerned with the description of chiropractic services included in HR 5909. The current wording specifies that the VA plan for chiropractic shall include "care for neuromusculoskeletal conditions typical of those affecting all age groups within the eligible veterans population..."

This terminology has the effect of defining chiropractic as a treatment for neuromusculoskeletal conditions, which is inaccurate. For many, if not most, chiropractors, chiropractic is not a form of medical treatment but rather a unique health care discipline dealing with the correction of vertebral subluxation.

For more than 25 years, chiropractic has been covered as a Medicare benefit in 42 USC 1395x (5), which limits chiropractic services to manual correction of spinal subluxations. The Medicare benefit does not include physical therapy services. The only "condition" covered is spinal subluxation.

The diagnosis and correction of vertebral subluxation is also the purpose which defines chiropractic in most state licensing laws and is the definition supported by the Council on Chiropractic Practice Clinical Practice Guideline, Number 1, "Vertebral Subluxation in Chiropractic Practice," which has been endorsed and adopted by numerous state, regional, and national chiropractic associations.

Finally, it is the definition used by the World Chiropractic Alliance, in its role as an NGO with the United Nations Department of Public Information, when working with other health care officials worldwide and during its discussions with the World Health Organization.

To understand the controversy raised by this bill, it is important to realize that there are two major schools of thought in the chiropractic profession.

The first is committed to positioning chiropractic as a separate and distinct discipline in the healing arts, which does not duplicate existing medical services. It is directed toward the correction of vertebral subluxations, which interfere with the function of the nervous system.

The second school of thought considers chiropractic to be a limited medical specialty for the treatment of certain musculoskeletal disorders. Proponents of this position embrace a broad array of therapeutic interventions including manipulation and physical therapy modalities. This necessarily encroaches on the practice of medicine and physical therapy.

By failing to define chiropractic as the analysis and correction of vertebral subluxation, the current wording in HR 5909 excludes an entire category of chiropractic. If passed with this wording, thousands of licensed, capable doctors of chiropractic would be virtually barred from providing subluxation-correction services through the VA system.

The WCA and the thousands of doctors of chiropractic it represents cannot support any legislation that excludes a large portion of the profession. In order to win support, any proposal involving chiropractic services within the VA system needs to cover the following:

1. Chiropractic examination and adjustment to correct vertebral subluxations -- Physical therapy and rehabilitation services are already available within the VA system; chiropractic examination and adjustment to correct vertebral subluxations are not. This provides consistency with the other existing Federal program, is the more cost-effective approach, and satisfies legislative intent.

2. Direct access to chiropractic care -- Only a chiropractor is qualified to determine the appropriateness of chiropractic care. Direct access would also eliminate the costs associated with a screening process by other providers.

3. Adoption of Council on Chiropractic Practice Clinical Practice Guideline Number 1, "Vertebral Subluxation in Chiropractic Practice" -- This evidence-based guideline is current and was distributed to U.S. chiropractors in 1999. It was produced by an interdisciplinary expert panel, and underwent peer review by 195 chiropractors in 12 countries. The Guideline was the first to be included in the AHCPR National Guideline Clearinghouse.

The World Chiropractic Alliance and the thousands of subluxation-based chiropractors it represents throughout the world stand ready to work with Congress as it moves toward a full and comprehensive role for chiropractic in the VA.