WHO develops guidelines on chiropractic basic
training and safety
A special report by Asher Nadler, DC
and Yannick Pauli, DC.
For several years, the World Health
Organization (WHO) has been working on a strategy to facilitate the
integration of traditional and complementary/alternative medicines into the
national health system of its Member States as well as to promote the proper
use by consumers of those traditional and complementary approaches.
Because chiropractic is now practiced
worldwide in more than 100 countries, it is among the first professions that
WHO looked at in its process of guidelines development.
The WHO Consultation on Chiropractic
that took place on December 2-4, 2004 in Milan, Italy is the result of
several years of cooperative work between the WHO and chiropractic
organizations, such as the World Chiropractic Alliance (WCA).
At the invitation of the WHO,
chiropractic experts from around the world met to discuss the final draft of
the “WHO Guidelines on Basic Training and Safety in Chiropractic.” Those
guidelines, due to be released in early 2005, have three major objectives:
¨
To provide minimum
requirement for chiropractic education
¨
To serve as reference
for national authorities in the establishment of systems for the education
and licensing for the qualified practice of chiropractic
¨
To review
contraindications and ensure the safe practice of chiropractic.
The Guidelines are the
culminating point of a process that involved the participation of 167
chiropractic experts in 53 countries, 54 national health authorities in 37
countries and 52 international and regional chiropractic organizations.
Representing the WCA were Dr. Asher
Nadler, a member of the WCA International Board of Governors and president
of Israel Doctors of Chiropractic and Dr. Yannick Pauli, a member of the WCA
International Board of Governors and WCA liaison to the WHO.
Also in attendance were 30 other
experts from various fields. Representing chiropractic were: David
Chapman-Smith, secretary-general of the World Federation of Chiropractic (WFC);
Dr. Anthony Metcalf, WFC president; Dr. Martin Camara from the Philippines;
Dr. Ricardo Fujikawa, WFC council member for Latin America; Dr. Ed Lee from
Hong Kong; Dr. Jean-Pierre Meersseman from Italy; Dr. Koichi Nakagaki from
Japan; Dr. Jonh Sweany from Australia; Dr. Jean Moss, president of the
Association of Chiropractic Colleges; Dr. Peter Dixon, past president of the
European Chiropractors Union; and Dr. Anfinn Kilvaer, past president of the
European Council on Chiropractic Education. The rest of the participants
included three osteopaths, one medical doctor specializing in manual
medicine and representatives of national health authorities.
The meeting was sponsored by the
Government of Lombardy, Italy and led by Dr. Xiaorui Zhang, coordinator of
the Traditional Medicine department of the WHO.
Minimal requirements for chiropractic education
Most of the meeting was spent
discussing minimal requirements for chiropractic education. This issue is
not so obvious for countries where the practice of chiropractic is regulated
by law. It is, however, of utmost importance for countries where no
chiropractic legislations yet exist.
There are examples of countries where
medical groups have organized “chiropractic training” in short courses of
200 hours or less. In other countries, practitioners are calling themselves
chiropractors although they do not have formal chiropractic training. This
is the case in Japan where 10,000 practitioners originating from the local
bone setting tradition practice some form of manual therapy, calling
themselves “chiropractors.”
The new guidelines now clarify the
issue by recommending minimal requirements for the qualified practice of
chiropractic. For example, they make it clear that a graduate from medical
school will require a minimum of 1,800 hours, with no less than 1,000 hours
of clinical experience.
Representing wellness-oriented, subluxation-based
chiropractic
The WCA has been in relationship with
the WHO for several years, more particularly with Dr. Zhang and her staff.
Because many of the experts selected were WFC officers or affiliated with
the WFC, the presence of WCA representatives was essential in insuring that
the voice of chiropractors practicing wellness-oriented, subluxation-based
chiropractic be heard.
The presence of the WCA has insured
that references to vertebral subluxation are included in the document. For
example, the guidelines stipulate that chiropractic graduate must “achieve a
fundamental knowledge of health sciences, with a particular emphasis on
those related to vertebral subluxation and /or to the neuromusculoskeletal
system.” Subluxation and Vertebral Subluxation Complex are both defined in
the glossary of the document.
Although in minority, the WCA was able
to insure that it was made clear that the chiropractic profession places a
particular focus on the subluxation and that chiropractic adjustments are
used to influence neuro-physiological function and, as such, are different
from joint or spinal manipulation.
In that context, the
document refers to contraindication to spinal or joint manipulation, and not
to chiropractic specific adjustment. Whereas a medical condition of the
spine may contraindicate the delivery of a spinal manipulation, it does not
necessarily do so for the delivery of a chiropractic adjustment, such as
those used, for example, in low force techniques.
The guidelines also explain that
chiropractic is not a technique, but a profession. Although adjustments --
and for some chiropractors other manual approaches -- are central to
chiropractic care, the latter also include patient education, exercise and
other health-promoting strategies.
The World Chiropractic Alliance is
proud to have participated in such an important project and will continue
its cooperative effort with the WHO on international chiropractic issues.
