New Zealand 20 Years Later: Can We Learn Anything?
By Louis Sportelli, DCIn 1979, Chiropractic in New Zealand: Report of the Commission of Inquiry was released to the New Zealand House of Representatives by the governor-general. The report was commissioned to determine the desirability of providing health benefits under the Social Security Act of 1964 and medical- related benefits under the Accident Compensation Act of 1972 with respect to the performance of chiropractic services. The commission was directed to consider:
1) the practice and philosophy of chiropractic, its scientific and educational basis, and whether it constitutes a separate and distinct healing art; 2) the contribution chiropractic could make to the health services of New Zealand; 3) any other matters thought by the commission to be relevant to the general objectives of the inquiry.
The commission was presented with quite a challenge by the governor-general, on January 24th, 1978. Little did the commission know what would develop and emerge from an inquiry that took them literally around the world.
It is not often that one has an opportunity to "go back to the original members" of a commission 20 years later, to probe a bit into the thoughts and feelings of what they were thinking and to reflect on what has transpired since the release of their report.
Those who attended the World Federation of Chiropractic's congress and educational conference in Auckland were privileged to hear those observations.
The New Zealand Chiropractic Association and the Chiropractic Association of Australia jointly hosted the educational session and presented a few memorable hours of presentations by some of those who participated in the culmination of the New Zealand report on chiropractic.
The chairman of the New Zealand Commission was Brinsley Donald Inglis of Wellington (now a judge). The other two commission members were Thomas Athol Rafter of Wellington (a scientist) and Betty Fraser of Wellington (a headmistress). All three were in attendance at the 1999 conference. Judge Inglis made some excellent comments about the quality of the chiropractic presenters and the credibility of the witnesses who spoke for chiropractic. He was impressive in his presentation and eloquent in his delivery on a project that no one could have envisioned 20 years ago would culminate in a report that had such an enormous impact on the chiropractic profession. The other two members were also in the audience and were recognized for the roles they played.
Mr. R.J. Craddock, counsel for the New Zealand Chiropractors Association, voted top barrister in New Zealand, spoke of his early involvement and uncertain aspects of the initial reason he was retained. His experiences were similar to the AMA litigation in the U.S. and the 17 years of continual involvement by George McAndrews, counsel for the chiropractic plaintiffs. Mr. Craddock recognized and gave credit to his young associate, David Chapman-Smith, who has continued his exemplary career in chiropractic advocacy and now serves as secretary-general of the World Federation of Chiropractic.
Dr. L.C. Mudgway of New Zealand was the president of the New Zealand association and recounted for the audience his trepidation of the inquiry. The association was told that no one would have to testify. When all was said and done, he was "selected" and, despite the lack of preparation, the commission found f individual chiropractors such as Dr. Mudgway to be honest, efficient and dedicated to their patients. Dr. Mudgway offered convincing evidence to the commission.
A major highlight of the testimony 20 years ago was the emotional presentation made by two patients. The first was made by an elderly woman who suffered from a whiplash injury, high blood pressure and water retention. Following chiropractic care, her conditions were alleviated. The commission was impressed; the medical association appalled; the doctor of chiropractic was a reasonable man and the patient was helped. That patient today is 97 years old.
The story told by the second patient however, was enough to cause anyone who heard it to not only be incredulous, but to want solid evidence of the story. The patient related his story as having been involved in an auto accident and getting pinned against the wall by the auto. He was taken to the neurosurgical unit of the hospital and remained there for two and a half years, ultimately paralyzed from the waist down. He had no sense of balance and could not support his weight in a chair. He recounted for the audience how he could fit his thumb and forefinger around his thigh. He was destined to live in a wheelchair the rest of his life. His mother refused to send him to a special unit and attempted to care for him in a home that was ill-equipped for a wheelchair. He recounted how he literally attempted to crawl to use the outside lavatory facilities.
After considerable prodding, the patient sought the services of a chiropractor. He took his first steps six months later and had returned to normal physical health in approximately a year. He now works 10-12 hours a day and has run a marathon. This miracle story, coupled with the humility of the chiropractor, impressed the commission. The stories of patients who had been helped by chiropractic played a significant role in the conclusions reached by the commission.
Robin McKenzie is a well-known physiotherapist who was at the conference. Twenty years ago Mr. McKenzie testified in opposition to chiropractic in New Zealand. At the conference he recounted the reversal of his old opinion and his denunciation of much of physiotherapy as "hocus-pocus." He spoke of his growing appreciation of the role of the doctor of chiropractic and the skill, training and education of the DC.
The McKenzie technique, founded by Robin McKenzie, is taught all over the world and is utilized by many doctors of chiropractic in conjunction with their specific spinal manipulation. Mr. McKenzie was honest, impressive and credible in outlining his journey from opposition to support after knowing the facts.
Finally, Dr. Scott Haldeman, who currently chairs the research council for the World Federation of Chiropractic, spoke to the audience. Undoubtedly, Dr. Haldeman has been one of the most significant figures in advancing chiropractic in the research and scientific arenas. The commission members and the New Zealand attorney recalled Dr.
Dr. Haldeman recounted his understanding in 1979 of the "subluxation" and its neurological, muscular and vascular components. His training as a doctor of both chiropractic and medicine made his presentation and experience in neurophysiology a rational basis for chiropractic to achieve the results it did. In a reasoned and articulate fashion, Dr. Haldeman brought to the commission the basis for why chirpractors are able to achieve results with the evidence known in 1979. He concluded that more research was not only necessary but imperative, and subsequently dedicated much of his professional career to advancing the cause of chiropractic research. Much is owed to this singular individual who has been a model of professionalism, integrity and principle to the cadre of researchers who have followed his example since the mid-1970s.
Finally came David Chapman-Smith, who at the time was a young attorney and could not have possibly known the path his life would take after his involvement with the New Zealand commission. He has gone on to become a very significant figure in chiropractic. His masterful organizational ability has caused the World Federation of Chiropractic to not only achieve non-governmental status (NGO) with the World Health Organization, but has managed in 10 short years to create one of the most powerful world organizations in chiropractic. His leadership, commitment and vision have undoubtedly advanced the profession worldwide.
What can we learn 20 years later? It would be of interest for each doctor of chiropractic in the world to go back and read the 1979 Chiropractic in New Zealand report. How far have we advanced? How much have we regressed?
Undoubtedly, in the area of scientific research, the profession has made light years of progress. Thanks to the funding of research by NCMIC Insurance Company, FACE, FCER (and last year even the federal government in supporting the Chiropractic Consortium), chiropractic has made a lasting impression in the world of research. There is never enough money, researchers or evidence to say we don't need to do anything else. The profession can be thankful for the researchers in chiropractic who have dedicated themselves to advancing the profession.
To those who have sacrificed personal and economic advancement to further their dedication to research, a debt of appreciation is owed. Undoubtedly, there is a growing body of researchers. In reviewing the early NINDS monograph, it was noted that Haldeman, Grice, Gitelman, Janse, Day, Drum, Howe, Jenness, Kent, Kleynhans, Martin, Mazzarelli, West and Wymore were the original presenters. A few were researchers; a few were political invitations; and still others were hand-selected. The choices in 1975 were very limited.
Today, however, we have a growing cadre of researchers: Haldeman; Triano; Phillips; Vernon; Mior; Cassidy; Breen; Bolton; Budgell; Giles; McGregor; Hurwitz; Meeker; Mootz; Smith and others who are setting the research agenda for the next century. The profession is truly blessed.
Before I offend anyone, this list is undoubtedly incomplete, and no intention is made to slight any of the researchers not mentioned here. The world is changing so rapidly that there could be no complete list, as each of the colleges around the world is producing scientists, researchers and chiropractors. The names mentioned in this article are for illustration only and demonstrate the growing body of academic and scientific advancements made by doctors of chiropractic. How far we have come in 25 short years, and what an impact the profession has made on the scientific community.
In other areas we have failed miserably. The New Zealand commission outlined considerable opposition to brochures and pamphlets which make claims and statements for which there is no validation. Do we still do that today? There is some evidence that the profession is attempting to clean up its own materials, and there is also growing evidence in America that the FDA will view unfounded claims by individuals and organizations as actionable.
Chiropractic education was the subject of inquiry in 1979 and was summarized by the following statement: "A chiropractor's professional education must equip him to be a diagnostician competent at least to detect contraindications for chiropractic treatment, a limited field radiographer, and a skilled manual therapist." In the United States, there is still controversy over entrance requirements, and rumors of new "private" colleges still abound. The rest of the world is demonstrating the educational growth of chiropractic by affiliating with universities. Even today, however, opposition to affiliation is still present: witness CMCC, York University and the Canadian controversy. Many other countries with less organized opposition are affiliating with universities as the working model.
The relationship between Chiropractic and medicine is another problem still to be reckoned with. In the U.S., evidence of political medicine opposing chiropractic is still rampant despite AMA litigation. Because of the litigation, it has taken a new underhanded method to achieve its goal of a medical health care monopoly. In Canada, Australia and other parts of the world, organized medicine still fights the chiropractic profession. In lesser developed countries, the opposition is less, but ever present. The fortunate aspect for chiropractic is that the body of evidence supporting the profession is growing, and the decision makers are less likely to believe the political claims -- New Zealand 20 years ago, only with more evidence to support chiropractic's claims.
Finally, there is the issue of chiropractic unity among the profession. Here, we have failed miserably. In the U.S., the numbers of both national organizations continue to decline. Collectively, they represent less than 20% of all the practicing DCs in the country. In-fighting continues, and a new state profession forms almost regularly to further fragment and polarize the profession. In Canada, the strength of the CCA is significant, yet influences from outside the country and in-fighting from within by small groups continue to weaken the organization. In many countries around the world, if two chiropractors exist, there are two separate organizations.
The World Federation of Chiropractic (WFC) has performed magnificently in the area of unity. Countries around the world need significant help which can be provided by the WFC, however, one organization is mandated by the WFC to receive support. The world is changing rapidly. With strong singular voices from organizations of chiropractic around the world, much can (and is) being done to achieve parity, recognition, influence, licensure and credibility.
Twenty years ago, New Zealand was a benchmark for chiropractic. It should confirm the fact that history ignored is history repeated. Many researchers after reading this article may find they are uplifted, as they should be. Many politicians may feel they have been harshly criticized and blamed for the profession's disorganized state, and perhaps a lesson in leadership is to be gained. Yet every individual doctor of chiropractic must complete his or her "report card" and grade themselves as to their support, participation, encouragement and contribution to advancing the profession. Without participation, there can be no "shared vision" to move chiropractic forward. In 20 years, what have we learned?
Finally, communication is a key factor. Your ability to read this column, whether as a lone practitioner in Zimbabwe or Lebanon, or in the U.S. or Australia where chiropractic is organized, is significant. Dynamic Chiropractic has provided a communication link to the world. DC, in newspaper form or on line, has given the ability to distribute information instantaneously and accurately to everyone. The internet, with all its potential for harm, has enabled chiropractors to communicate.
The next century will demand new solutions for new problems. Leadership of each entity will have to redesign its mission and reinvent its reason to be, simply because the profession will be connected and informed on the issues. Those who elect to be leaders will face greater opportunities and greater challenges in the quest to advance chiropractic.
New Zealand provides an opportunity to reflect on the future. What will we do when 2020 is here? Will we still be writing about what we did not do, or will the record reveal a profession that has taken on the challenge and won?
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