Interview with Stephen Welsh, DC
On April 29, 2019, the International Chiropractors Association (ICA) filed a formal complaint against two members of the World Federation of Chiropractic (WFC) Research Committee, Gregory Kawchuk, and Jan Hartvigsen, asserting that they had violated the WFC principles of governance during the 2019 WFC Biennial Congress in Berlin.
The ICA contended that the world chiropractic stage provided by the WFC was being used to advance a divisive political agenda. This agenda demonstrated a level of intolerance and disrespect for traditional chiropractic practice that should not be acceptable in an organization that had been founded on principles of diversity and inclusiveness.
The whole conflict began with the publication of a paper co-authored by the previously mentioned research committee members in February 2019. This paper, now popularly referred to as the “Divorce Paper,” [1] asserted that the WFC had signaled a policy shift by abandoning attempts at “unity,” and claimed that the practice of traditional chiropractic was not compatible with the self-described “official” evidence-friendly chiropractic profession (this position was then promoted by Dr. Kawchuk from the Berlin WFC biennial stage).
The clash then escalated with the publication of a paper in that same online journal, “Chiropractic & Manual Therapy”, which openly criticized the ICA for publishing a white paper calling for more research into the relationship between chiropractic and the immune system. This positional statement by these WFC research council members, titled “A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity,” [2] directly criticized the ICA white paper position for suggesting that there is “an association between spinal manipulation and the autonomic nervous system” and that “these studies suggest mechanisms by which spinal influences may mediate a clinically significant impact on immune function.”
The “Divorce Paper,” was subsequently used as a reference in a complaint filed by eight national chiropractic associations seeking to have the ICA removed from participation at the WFC. These eight national associations asserted that the ICA is damaging the reputation of the Chiropractic profession and that as evidence-based associations, they could not afford to be affiliated with an organization promoting these ‘dangerous and unproven claims. ’
The American Chiropractor (TAC) caught up with the President of the ICA, Dr. Stephen Welsh (SW), to understand what is going on between these two important Associations.
TAC: How did the International Chiropractors Association begin working with the World Federation of Chiropractic? Can you tell our readers a little about the history of WFC?
SW: The ICA played a significant role in the creation of the WFC. In May 1987, ICA Board member Dr. Gary Auerbach attended the General Assembly of the WHO in Geneva with ICA Legal Advisor Mr. David Chapman-Smith. In their report to the ICA Board in June 1987, a recommendation was made to create a World Federation of National Chiropractic Organizations in order to gain NGO status at the WHO.
The World Federation of Chiropractic was established in Sydney, Australia on October 2, 1988, and at the first council meeting in September 1989, Dr. Gary Auerbach was elected its first President, and David Chapman-Smith became the Secretary-General. The WFC did gain NGO status in January 1997.
TAC: Can you give some insight on what is happening with the ICA and the WFC?
SW: Following the events in Berlin in March of 2019, it has become apparent that there are a group of academics and chiropractic researchers that have been promoting a flawed evidenced-based chiropractic paradigm that has at its core a rejection of D.D. Palmer basic foundational tenets. This group goes so far as to refer to the basic tenets of chiropractic as pseudoscience. These researchers have recently escalated their criticisms of the ICA and those criticisms have influenced several European Chiropractic Associations. These associations have filed a complaint. The ICA has always been a staunch supporter of the ideals and objectives of the WFC and continues to maintain that traditional chiropractic is evidenced-based and that arguments to the contrary are based upon a false premise.
In its initial complaint in June 2019, the ICA asserted that “... the model of practice chosen by the individual chiropractic practitioner, academic or researcher does not negate the validity of the model chosen by their colleagues. The underlying foundational principles of the WFC include an acknowledgment and respect for the variations that exist between international jurisdictions.”
TAC: How do you see the ICA working to shape the future of chiropractic in the coming years and decades?
SW: Since its founding in 1926 by Dr. B.J. Palmer, the ICA mission has been to protect and promote chiropractic throughout the world as a separate and distinct health care profession predicated upon its unique philosophy, science, and art. Fifty years ago it was the ICA that initially supported the Wilks case and called for greater unity within the profession in order to take on the predatory practices of the American Medical Association (AMA). As chiropractic continues to grow outside the United States, many countries are beginning to experience that same anti-competitive (restraint of trade) behavior. The ICA is once again calling for greater unity within the profession. Last year the ICA Board approved 5 new value statements dealing with Respect, Equitability, Empowerment, Collaboration, and Transparency. The ICA hopes to set the standard and, by example, facilitate the collaboration necessary to move this profession to the next level.
TAC: What trend do you see amongst chiropractors is the most concerning through the lens of the mission and vision of the ICA?
SW: Since the success of the Wilks case over thirty years ago, there seems to be an increasing number of groups attempting to define chiropractic according to their terms. One group wants prescription drug rights, another wants to be the spine care experts, another group wants to practice functional medicine, and yet another wants to be just back pain specialists. It seems that today the profession is more divided than ever and that plays into the hands of our competitors in the healthcare marketplace. As a profession, it is time to elevate our game. It is time to respect all of the various practice styles, devote some resources to do more of the clinical research that has received so little funding in the past. It is time to respect our differences and focus on what we all have in common. We are all chiropractors. Having access to a quality chiropractor, even one whose focus is different is better for the public than having access to no chiropractor.
TAC: What is the ICA doing today to represent the needs of its chiropractors?
SW: The ICA is actively engaging with policymakers both in the United States and in countries around the world to defend the rights of its members to practice traditional chiropractic.
1987 -> ICA Recommends the creation of a World Federation of National Chiropractic Organizations in order to gain NGO status at the WHO.
1988 OCTOBER -> The World Federation of Chiropractic was established in Sydney, Australia on October 2.
1989 SEPTEMBER -> ICA Board member Dr. Gary Auerbach was elected the 1st president of WFC
1997 -> The WFC gains NGO status in January 1997.
2019 FEBRUARY -> Gregory Kawchuk & Jan Hartvisgen co-authored “Chiropractic, one big unhappy family: better together or apart?”
2019 MARCH -> Promotion of “Divorce Paper” at Berlin Conference
2019 APRIL -> ICA files formal complaint against Gregory Kawchuk & Jan Hartvisgen of the World Federation of Chiropractic Research Committee.
2020 MARCH -> ICA publishes immunity white paper
2020 APRIL -> Gregory Kawchuk & Jan Hartvisgen coauthor ‘Pseudoscience’ Paper
2020 JUNE -> Eight National Chiropractic Associations file complaint against ICA based upon online research paper.
During the COVID pandemic, we were the first to publish a reminder that chiropractors are essential health care providers. We have engaged with state and federal authorities with a focus on educating on this fact, as well as providing factual information and assistance as requested. We established and continue to update a COVID resource page that has global coverage and I began doing regular videos for our membership.
• We are actively engaging with the Legislative and Executive branches of the U.S. federal government on eliminating the disparity policies for coverage and reimbursement of Doctors of Chiropractic and their patients in federal health care funded or managed programs. This includes HHS, VA, and DOD as well as Congress.
• A top priority is Medicare, where we are focused specifically on eliminating the disparity in the treatment of chiropractors to other physician-level providers, focused on the three top requests - reimbursement of exams and x-rays for chiropractic offices, and inclusion in the right for patients to privately contract with chiropractors (commonly referred to as the Opt-Out provision). And we are doing so while protecting the subluxation terminology in the definition of chiropractic rather than relegating it to a footnote.
We are actively promoting the need for increased research resources for chiropractic colleges and have begun raising money for subluxation-focused research.
° We also have begun the discussion and will continue doing so about the important opportunity that practiced-based research and research networks will offer to expand the evidence base.
° The importance of promoting quality clinical research that extends beyond the short term, or single thrust approach and expands to look at the whole person effect of regular chiropractic care.
° The need for more basic science in chiropractic care.
° Better understanding the whole body of evidence that supports chiropractic care, including research from outside the profession.
We continue to educate about and promote the importance of chiropractic as a first line of care in pain management to reduce the incidence of opioid abuse/addiction.
We responded to a proposed regulatory change in British Columbia that would place restrictions on the use of x-rays based upon another flawed and rapid review.
• We regularly engage at the National Institutes of Health and its National Center for Complementary and Integrative Health.
• In July 2019 we published in conjunction with the ABCA an important paper on advancing diversity in the chiropractic profession and presented this report to the CCE. We have launched an Ad Hoc Advisory Committee on Adversity and Inclusion chaired by Dr. Selina Sigafoose-Jackson, and we hosted our first webinar in September on Diversity with Dr. Derrell Blackburn, a member of our Representative Assembly and a member of the Advisory Council.
TAC: What do you see as a potential resolution to what appears to be an escalating war of words?
SW: The ICA understands that the Board of the WFC has been placed into a very uncomfortable position. They have the responsibility to referee the escalating differences between the different views of what is in the long-term interests of the chiropractic profession. Unfortunately, the lack of action to date is being interpreted by many in the United States, including the ICA, as an unwillingness to defend the rights of chiropractors around the world to practice traditional chiropractic. If the WFC will not, the IC A will... because that has been the primary mission of the ICA for 94 years.
TAC: Anything else important for this story that you want to share with our readers?
SW: There has always, however, been a tension between those that practice traditional chiropractic as it legally defined here in the United States and those seeking greater acceptance from the medical community in other countries. In the early years the WFC policies were heavily influenced by the United States. The WFC Assembly adopted the 1996 ACC paradigm at its biennial Congress in Paris in 2001, but that model seems to no longer be relevant to some chiropractic researchers. That paradigm had two key elements that are now being publicly rejected by the leadership of the WFC Research Committee and the 8 referenced national chiropractic associations:
“PURPOSE: The purpose of chiropractic is to optimize health.”
“PRINCIPLE: The body’s innate recuperative power is affected by and integrated through the nervous system.”
These two elements are embodied in the legal definition of chiropractic in all fifty states where approximately 75% of all chiropractors in the world practice.
The ICA and others within our profession are very concerned at the lack of diversity of thought on the WFC’s various committees. And the obvious bias among some of its leadership. For example, The Chair of the Disability Committee published an opinion in a Canadian newspaper in which he stated, “Chiropractors who adhere to vitalism and chiropractic subluxation theories are a danger to patients 'health and a threat to public health. These chiropractors hide behind naive, illogical\ and pseudoscientific beliefs and put their personal interests ahead ofpatients ’ wellbeing. There is no valid scientific evidence supporting vitalism and the concept of subluxation. Chiropractors who adjust subluxations to prevent disease (a concept undefinable scientifically and unmeasurable clinically) or remove subluxations to cure illnesses (a dogma that ignores what is known about the causes of disease) should be investigated by the College of Chiropractors of Ontario because they may put their patients’ health at risk If the CCO is unwilling to protect the public’s best interests, then government should regulate chiropractic in Ontario." [3]
The ICA remains optimistic that the majority of chiropractors and their respective associations can commit to develop a “Unity of Purpose,” and commit to a level of cooperation & collaborate to expand chiropractic worldwide.
You may send Dr. Welsh an e-mail to swelsh(a)„mindspring. com. and to learn more about the ICA involvement in this process visit: www.chiropractic.org/.
References
1. Leboeuf-Yde, C., et al, Chiropractic, one big unhappy family: better together or apart? Chiropr Man Therap, 2019. 27: p. 4.
2. Cote, P., et al., A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity. Chiropr Man Therap, 2020. 28(1): p. 21.
3. Cote, P., Re Critics Call For Outside Regulation Of Chiropractors (Jan. 2), in Globe and Mail 2019: Globe and Mail.
