Despite these advances, our collaboration with WHO has not been without controversy.  There are some in the chiropractic profession who have criticized our participation in the organization.  Some feel that we are not doing enough chiropractic-centric work.  Others feel that are we not doing enough to promote the chiropractic philosophy of healing internally and while it may seem from the outside that the bureaucracy of such a large organization may dilute our contributions, I believe such opinions are a matter of perspective.   Work at WHO is a thankless job.  The hours are long and recognition is rare.  It takes a minimum of 18 months and as long as 5 years for most documents to be published which means that technical officers often find themselves caught in the cogs of the Marxist machine.  Grassroots work is dirty and dangerous and most WHO doctors rarely connect to the patients whose lives they dreamed of impacting when they were in school.  Suffice it to say, policy-writing can be tedious and the final product could outlive the work of any one individual.  With this in mind, detractors must be aware that public service within the construct of the social norm is the necessary price we must pay for progress.  Chiropractors are too frequently encouraged to abandon institution and seek personal and professional success after graduation at the expense of a larger vision.   Misnomers such as “chiropractic principle” and “chiropractic philosophy” are the rallying cries of an embattled minority which have frequently muddied the waters of professional identity.  We have shown in our short time at WHO that we have much to contribute, but re-writing the book on healthcare delivery is neither necessary nor justified.   As Dr. Gerald Clum said at the 29^th World Congress of Chiropractic Students in Mexico City, “the right over the adjusting table comes from time spent at the conference table.”  We finally have a seat at the largest table in the world.  Let us not abuse it.

It goes without saying that global health care delivery systems need us.  We are poised, confident and knowledgeable.  We bring a fresh perspective to an often tired debate and create new opportunities for the realization of sustainable health among populations with no access to essential medicines, quality sanitation and nutritious food, but we have work to do in order to be maximally effective.  Of primary importance is the need for the most vocal of us, as I’ve argued before, to “get smart and get humble.”  Too often do we allow our educational system to become polluted with the perpetuation of religious pseudoscience touted as fact.  By all means, we must continue to think outside the box and push the boundaries of science, but critical rationalism must replace a desperate reliance on practice management for the sake of patient safety.  We must acknowledge our weaknesses just as we tout our strengths and work alongside scientists outside of the profession to maximize our effect.  We owe it to ourselves to develop a culture of perpetual learning.  As Albert Einstein is frequently quoted as saying, “we cannot solve our problems with the same thinking we used when we created them.”  Relying on the philosophical mantras of a few dead charismatic figures will not help us progress.  There is still much for us to learn and we must espouse a rigorous culture of scientific discovery in order to realize this.   Additionally, we must not be afraid to branch out.  Few will argue that participation in entities like the American Public Health Association and the National Institutes of Health has helped to open the floodgates of acceptance in the US.  We have cultivated political alliances with figures such as Representative Tom Harkin who has adopted our cause and rallied it in the United States Congress.  Our presence at WHO is no different, save the magnitude of our potential impact.  I believe that it is only a matter of time until a chiropractor chairs one of WHO’s higher projects, committees, units or clusters and with this responsibility will come huge promise.  I have learned that we can continue to focus on ourselves and perish or show the world how vital we are and flourish.  This is our generation’s calling and our legacy; the foundation is already laid.  All that is required is additional momentum in the form of institutional support and unified collaboration.  The only remaining question is, as I asked in a previous post, “who will carry the torch?”

The answer must necessarily be each and every one of us.  Join the cause, support your national and international associations that pour resources into the realization of this vision and leave a lasting legacy for the next generation to follow.

For information about internship opportunities at WHO, please visit: http://www.who.int/employment/internship/en/.

Chiropractic as a profession is still in its infancy in terms of participation in the realm of public health, despite the fact that most chiropractors advocate health and prevention as part of their care regimens.  We have only recently begun to participate in organizations such as the American Public Health Association and have yet to contribute significant scholarship to the academic field of health or global health delivery.  Much of this void comes from our academic culture’s failure to promote opportunities to contribute to the public health community at large, although some chiropractic colleges such as the Southern California University of Health Sciences and Northwestern Health Sciences University have recently taken first steps by supplementing students’ memberships in the APHA.  Chiropractic students have few options available to them while in school other than to become clinically competent in preparation for clinical practice.  Several chiropractic academics have hinted about creating a culture of “chiropractor scientists” which is currently drastically under-prioritized.  How can we expect to cultivate a culture of collaboration when our institutions do not provide the means by which students can explore the impact of chiropractic outside of chiropractic?  What I discovered in Alexandria is that we already belong to the greater health care culture.  We provide our patients with a service that many of our peers at the conference appreciated and in some cases, envied.  We were able imbue healing with a sense of humanity that has been stripped away by years of reductionist science, and while we did not eschew scientific method we acknowledged that modern medicine had much to learn, as do we.

Apparent also at this conference was the fact that CCE-accredited chiropractic students are well educated in comparison to medical students elsewhere in the world.  We receive as many hours of scientific and clinical education as most international medical students and spend as much or more time in clinical internship.  Our weaknesses lay in the clarity of our understanding of utilization, however.  Chiropractors have argued for years over the philosophic meaning of the chiropractic adjustment and, specifically, how it should be applied, to whom and how frequently.  The truth is, most chiropractors do not know.  As many as 90% of chiropractors agree that subluxation is a clinically meaningful entity but have yet to come to a consensus about best practices protocols.  Many have argued that a lack of homogenization in clinical protocols mean that what we do depends on many different variables that cannot be reduced, including the patient’s constitution, the clinician’s intent, environmental cues and, perhaps most importantly, placebo.  The fact remains that this type of debate rarely occurs in allopathic medicine and was clearly a new language to many medical students we engaged in Egypt, especially those from less developed or developing countries.

Many students in attendance at the conference had no idea what chiropractic was, nor could they truly appreciate how our clinical skill set could be used to contribute to global health promotion until we came to the table with our unique perspective on health delivery.  This event, like the WHO internship, threw the global chiropractic dilemma into gross relief.  Despite our weaknesses, we have a unique opportunity to branch out and participate in the realization of a vision greater than our own.  Chiropractors are perfect for the role.  Many medical students we met in Egypt wanted what we have.  We are ready for full-scope global integration, and now is the time.

“We’re just rehearsing who we think we are…” – Karl Schubach

How does one reconcile their identity as a representative of a profession so misunderstood, controversial and sectarian as chiropractic?

–

In a recent article published in Chiropractic & Osteopathy[1], Keating et al discuss the difficulties dogma-masquerading-as-science has created for the chiropractic profession, especially in the US where chiropractic education has yet to integrate itself into greater academia.   The authors specifically indict the subluxation concept as a hypothetical “house of cards” that works to deconstruct our special paradigmatic authority in an evolving science-based healthcare environment.  This, it turns out, is not an uncommon plight from Keating who has published additional literature[2],[3],[4] citing modern chiropractic dogma as the partial evolution of a legal defense used to establish professional distinctness starting with the Shegataro Morikubo trial in 1907.   Other authors have argued that our continued adherence to an admittedly antiquated and dogmatic principle that has yet to be clearly validated has been the primary reason that chiropractors have remained marginalized, scrutinized and ridiculed for years, while other non-allopathic professions such as Podiatry and Osteopathy have flourished[5].

As I have discussed in earlier blog entries, the chiropractic profession has hit somewhat of a critical mass, standing at the cusp of a major paradigm shift in healthcare delivery and educational evolution.  At the 30th World Congress of Chiropractic Students in New Zealand, Bruce Lipton discussed the cyclical nature of paradigm evolution and suggested that the chiropractic profession will be poised at the front of the new healthcare movement as society begins to embrace a renewed appreciation for vitalism…sure, if only we could address our inherent identity crisis.  Don Murphy[5] argues that we can no longer afford to masquerade as a two unique professions under one roof.  He and Keating[6] argue that Chiropractic is, merely, what it is as defined in our slowly growing research base and despite our personal biases, we cannot allow ourselves to be swayed by personally satisfying, albeit alienating and possibly dangerously damaging pseudoscience.

In the context of WHO, an organization that strives to create recommendations for universal standards by which healthcare practitioners are deemed qualified, subluxation is a fairly troublesome phenomenon to quantify.  While the ACA, ICA, ACC, NBCE and WFC all acknowledge the existence of and define subluxation as a clinical entity, as does a good majority of the profession[7], little to none of the available literature supports these assertions in the traditional sense.  We may extrapolate on the meaning of DD Palmer’s original understanding of subluxation in his historical context based on some of the new, more compelling neuroscience literature that is available (see below), but the conjecture that subluxation is the “cause of all dis-ease” is far from validated, especially in the context of policy writing.  Just as we cannot allow professions such as allopathic medicine to make invalidated conjectural statements in their guidelines, so too must we behave within the framework of our scientific paradigm.

With this said and despite the lack of gold standard research directly validating the existence of subluxation, something must be said for clinical expertise.  My clinical and research experience tells me that we have a strong foundation to stand on in defense of the outcomes we observe with our patients, but I refuse to take academic conclusions at face value.  Contrary to Keating’s and Murphy’s apparent conclusions, I do believe there is an answer to the questions that the subluxation hypothesis poses, but it might not turn out to be what we had expected.  Research conducted by neuroscientists like Paul Bach-Y-Rita, Mike Merzanich, Edward Taub, and Vilayanur Ramachandran[8] as well as chiropractic scholars like Philip Bolton[9],[10],[11], David Seaman[12], Fred Carrick[13],[14],[15] and Heidi Taylor and Bernadette Murphy[16],[17],[18],[19],[20], suggest that we may have misinterpreted our care to be spine care when in fact it is really brain care.  The implications for clinical applications in neuroplasticity-oriented physical medicine are vast but are so poorly understood in chiropractic academia that it may be years before they are fully explored clinically.  I suspect we will discover that Palmer had the right idea but for the wrong reasons, which means that we could be limiting our potential by avoiding critical introspection.

As I have intimated in a previous post, major problems in our profession’s educational structure include overwhelming lack of emphasis on scientific appraisal, concomitant apathy amongst faculty towards lifelong learning and a history of grossly exaggerated extrapolation touted as truth in a clinical setting (for further exploration of this issue I would direct you to http://mollymerirobinson.wordpress.com).  We as a profession tend to believe whatever suits us because the lack of validation for our central dogma attacks what philosophers like Immanuel Kant, Soren Kierkegaard, Martin Heidegger and Jean-Paul Sartre have called our “world-view,” so we resort to religion in the same way Freud suggests we turn to God in his 1913 work Totem and Taboo.  I have commonly said having written my undergraduate thesis on American religious phenomena that one cannot expect to argue rationally in an “a-rational” context.  Heidegger argued almost 90 years ago that an individual person’s world-view is developed as an accumulation of subjective experiences and is therefore irrelevant without validation through scientific discovery, which should, ideally, be devoid of personal bias.  Such world-views carry both a promise of empowerment and simultaneous myopia.  While they help us reach our individual destinations on the road to personal truth their usefulness ends without appraisal, especially when they stand in opposition to logic.  In this vein, Don Murphy[5] argues that critical appraisal is the necessary price we must pay to accept the criteria of the “social contract” we agree to uphold with society in exchange for our clinical doctorates.  My feeling is that when one can successfully argue the clinical validity of subluxation to an academic neuroscientist, one is qualified to stand on it as a philosophical foundation; otherwise, that person is merely a priest practicing theology without a license.

–

Returning to my initial question, I believe it is important for us all to remind ourselves from time to time that it is ok to acknowledge our weaknesses while maintaining our core beliefs (see previous post).  The battle over subluxation has as much of a place at WHO as does a-rational philosophical squabbling over the validation of the bible, and our transparent division puts chiropractic at risk of graduating from a private national nuisance to a public international one.  As a WHO intern whose primary task is to work towards improving global healthcare delivery, the most effective means of leaving a lasting legacy is to spend each day pondering our profession’s promise and potential while using my unique perspective and skill set as a chiropractic student to help WHO more effectively realize its goals.  I am not a chiropractic intern; I am an intern who happens to be a chiropractor.  It is not my job to promote chiropractic here, but instead to use my special subjective understanding of human physiology, clinical practice and patient care to objectively troubleshoot, strategize and problem-solve.  This is both our gift and our legacy and should be at the forefront of every doctor’s mind when determining appropriateness of care for their patients.

[1] Keating, JC, KH Charlton, JP Grod, SM Perle, D. Sikorski, and JF Winterstein. “Subluxation: dogma or science?” Chiropractic and Osteopathy 13.17 (2005).

[2] Keating JC: Chiropractic: science and antiscience and pseudoscience, side by side. Skeptical Inquirer 1997, 21(4):37-43.

[3] Keating JC: Science and politics and the subluxation. Amer J Chiropr Med 1988, 1(3):107-10.

[4] Keating JC: Rationalism, empiricism and the philosophy of science in chiropractic. Chiropractic History 1990, 10(2):23-30.

[5] Murphy, DR, MJ Schneider, DR Seaman, SM Perle and CF Nelson.  “How can chiropractic become a respected mainstream profession?  The example of podiatry”  Chiropractic and Osteopathy 2008;16(10).

[6] Keating JC: Scientific epistemology and the status of chiropractic: we are what we do.  European J Chiropr 1993, 41(3):81-8.

[7] New study finds unity in chiropractic: surprising agreement among DCs on issues of philosophy, practice. Dynamic Chiropractic 21(12):1,8,10. 2003 (June 2).

[8] Doidge, Norman. The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science. London: Penguin (Non-Classics), 2007.

[9] Bolton, P. S., and B. S. Budgell. “Spinal manipulation and spinal mobilization influence different axial sensory beds.” Med Hypotheses 66.2 (2006): 258-62.

[10] Bolton, P. S. “Reflex effects of vertebral subluxations: the peripheral nervous system. An update.” J Manipulative Physiol Ther. 23.7 (2000): 512-13.

[11] Bolton, P. S. “The somatosensory system of the neck and its effects on the central nervous system.” J Manipulative Physiol Ther. 21.8 (1998): 553-63.

[12] Seaman, D. R., and J. F. Winterstein. “Dysafferentation: a novel term to describe the neuropathophysiological effects of joint complex dysfunction. A look at likely mechanisms of symptom generation.” J Manipulative Physiol Ther. 21.4 (1998): 267-80.

[13] Carrick, F. R. “Cervical radiculopathy: the diagnosis and treatment of pathomechanics in the cervical spine.” J Manipulative Physiol Ther. 6.3 (1983): 129-37.

[14] Carrick, F. R. “Changes in brain function after manipulation of the cervical spine.” J Manipulative Physiol Ther. 20.8 (1997): 529-45.

[15] Carrick, F. R., Oggero E, and Pagnacco G. “Posturographic changes associated with music listening.” J Altern Complement Med. 13.5 (2007): 519-26.

[16] Taylor, H. H., and B. Murphy. “Altered sensorimotor integration with cervical spine manipulation.” J Manipulative Physiol Ther. 31.2 (2008): 115-26.

[17] Haavik-Taylor, H., and B. Murphy. “Altered cortical integration of dual somatosensory input following the cessation of a 20 min period of repetitive muscle activity.” Exp Brain Res. 178.4 (2007): 488-98.

[18] Haavik-Taylor, H., and B. Murphy. “Cervical spine manipulation alters sensorimotor integration: a somatosensory evoked potential study.” Clin Neurophysiol. 118.2 (2007): 391-402.

[19] Murphy, B. A., H. Haavik-Taylor, S. A. Wilson, G. Oliphant, and K. M. Mathers. “Rapid reversible changes to multiple levels of the human somatosensory system following the cessation of repetitive contractions: a somatosensory evoked potential study.” Clin Neurophysiol. 114.8 (2003): 1531-537.

[20] Murphy, B. A., H. Haavik-Taylor, S. A. Wilson, J. A. Knight, K. M. Mathers, and S. Schug. “Changes in median nerve somatosensory transmission and motor output following transient deafferentation of the radial nerve in humans.” Clin Neurophysiol. 114.8 (2003): 1477-488.

…blank stare…

It had never occurred to me before this moment that the concept of chiropractic could be completely foreign to certain populations.  Because we typically interact with people who have previously heard of chiropractic but have preconceived notions about what we do, we spend much of our time selling our craft based on a pre-fabricated, albeit defensive construct.  My Rwandan intern friend threw a wrench in the spokes so to speak because he forced me to explain chiropractic in a language he could understand; one that is also, consequently, typically foreign to chiropractors.  A traditional definition of subluxation might as well have been translated into German because he wouldn’t have understood it either way.

In this context I decided to model my explanation around two concepts I was sure he was already familiar with: traditional medicine and neuroscience.  Because Chiropractic is defined as one of several disciplines categorized as manual practice under the Traditional Medicine umbrella at WHO, it helped to first put the profession in perspective while likening it to other non-allopathic health systems like Ayurveda and Chinese medicine as well as to some traditional African systems.  The hard part was to describe what we actually do to patients and how it affects them without using philosophical dogmatic principles, which can be an easy crutch when the mechanisms and underpinnings of our craft become hard to explain, especially to an “evidence-based” audience.  In this way, chiropractic modeled as a practice of a functional neurology paradigm predicated upon non-pharmaceutical intervention, prevention and wellness seemed to get the point across.

–

This experience thrust the importance of a project like the WHO internship into gross relief.  The power of perception carries a weight of influence in a pluralistic environment like WHO that makes an intern’s responsibility complex and multifaceted.  Therefore both education and tact are necessary prerequisites for an intern to be effective here, and while describing what we do by preaching the faults of a broken medical system in contrast to chiropractic superiority seems like a compelling undertaking, contemplation, diplomacy and paradigm-building have proven to be more appropriate means of building inertia towards scientific revolution.

The interns here are particularly amenable to new ideas.  Our generation is open to accepting the tools required of fostering a paradigm shift, but require the scientific blueprints necessary to make the leap.  Constant novelty is therefore required of the chiropractic profession in order to compel scientists such my Rwandan intern friend to accept the peculiar concepts I proposed to him.  Thomas Kuhn, in his book The Structure of Scientific Revolutions states that, “when the individual scientist can take a paradigm for granted, he need no longer, in his major works, attempt to build his field anew, starting from first principles and justifying the use of each concept introduced.” (19-20) I believe chiropractors too frequently, and unjustifiably, take their paradigm for granted, without contemplating and extrapolating it’s importance and therefore risk stifling their own scientific revolution.  It is becoming exceedingly necessary for chiropractors to found their defenses upon a basis of philosophical identity bolstered by constantly evolving, proactive scientific rigor.  The systematic review Dr. Robinson and I are producing establishes one of many firm philosophical foundations necessary to expound upon paradigmatically new neurologically complex concepts I used to describe our practice to both the interns and our staff subordinates.

In line with Kuhn, Kyle Popper admits in The Logic of Scientific Discovery, “that in arriving at [his] proposals [he has] been guided…by value judgments and predilections.  But [he hopes] that [his] proposals may be acceptable to those who value not only logical rigour but also freedom from dogmatism; who seek practical applicability, but are even more attracted by the adventure of science, and by discoveries which again and again confront us with new and unexpected questions, challenging us to try out new and hitherto undreamed-of answers.”  We can be content with our failures just as much as our successes as long as we do not embrace dogma at the expense of logic.  Describing chiropractic within a logical construct to a foreign population in the universal language of logic can be a successful endeavor, which carries with it no weight of religious judgment, or, therefore, potentially alienating non value-neutral connotations.

From my soapbox, I see this phenomenon occur all too frequently. Chiropractors and chiropractic students want so desperately to validate their paradigm that they fail to critically investigate the science behind it. The study in question sought to evaluate serum CD4 concentration levels in HIV positive patients after specific upper-cervical chiropractic manipulation. While the idea of a direct immunological outcome to chiropractic manipulation sounds enticing, the results of the study were simply too weak to warrant a public academic decree. Of the initial 22 subjects selected for inclusion, 12 failed to complete the study, leaving only 45% of the initial cohort available for statistical analysis. Indeed, the authors acknowledge that they “[could not] generalize [their] findings to the general population.” While the authors did report a 48% increase in CD4 cell levels in the 5 remaining experimental subjects they monitored versus the 5 control subjects who showed a 7.96% decrease, they could not validate the findings in light of the large amount of withdrawals. Additionally, it should be noted that the trial was not randomized and therefore cannot account for documented confounding phenomena such as placebo.

To be sure, the authors of this study should be applauded for their novelty. However, chiropractors must be aware that just because a study becomes published does not make it a dogma. As I have written before, the chiropractic profession stands on the cusp of a potentially powerful paradigm shift. It must be our primary responsibility to validate what we do to educated health pundits in the lexicon of modern science. The future of our profession will be dictated by the alliances we make outside the profession after carefully reviewing what we know, designing well-conceived trials to validate what we don’t and reporting true results in the vernacular of academia. At this stage in our history, I believe it is ok to acknowledge our limitations without sacrificing our core beliefs.

From the perspective of the WHO, whose policy-writers concern themselves primarily with safety outcomes and educational standards for traditional medicine practices, chiropractors need not be concerned with unfavorable outcomes of poorly designed studies, because it has already been established in a litany of well-acknowledged literature that chiropractic care is a viable healthcare intervention. However, we must be careful not to create too much inertia in favor of studies like the HIV study so as not to detract from what has already been established. Indeed, we can use such studies to reflect on what we have accomplished and what still need be done, but we must refrain at all costs from purporting results to the public that have either have no academic relevance or cannot be fully appraised by the reader to merely satisfy our personal voids of validation. The choices we make as a profession in the coming years will seal our collective destinies; will they compliment the landmark collaborative work we are doing at WHO or will they marginalize it?

Despite the fact that we have now had a doctor of chiropractic and several students working in the Traditional Medicine department for one year, it is still too soon to know what the impact of such participation will be.  Clearly, chiropractic can be forcibly fit within the confines of the department, but our role will need to be better defined over the coming years.  The good news is that the work we are doing now is creating positive momentum that will undoubtedly leave a lasting legacy.

WHO guidelines exist as professional recommendations to globally relevant governing bodies to ensure the highest quality of health care delivery.  Because chiropractic is so poorly defined in terms of traditional medicine, we risk creating regulatory disparity in countries without official policies (including the US) if our global public image is portrayed too cryptically.  In fact, I feel this is why we have had such difficulty establishing ourselves as the gatekeepers of neuromusculoskeletal care in the past.  We do, however, have the opportunity now to create a fresh, new foundation. Current research is exciting because it is finally beginning to validate our special 114-year-old paradigm.  With a clean slate, we can expect to build bridges with other CAM specialties in an integrated setting without sacrificing our core philosophies.  An immediate priority will be to validate the chiropractic profession’s safety record.  Having now reviewed the Cochrane database’s systematic reviews on efficacy, the WHO’s current policy statements regarding TM guidelines as well as a host of current literature regarding adverse events and safety, I am encouraged that we will soon be able to establish a sustainable majority opinion within the TM department that chiropractic practice, administered properly can perform efficiently in a CAM-emphasized health care delivery model, which means global governing bodies will have the tools they need to ensure chiropractic care is made available to the patients that need it.  This project will likely outlive my tenure here, but the foundation will soon be laid for future workers.

The fulfillment of this internship has created a critical mass for the rest of the profession, particularly in the United States where competing professional associations have driven more than 80% of licensed DCs away from political and legislative advocacy. Granted the six Chiropractic Summits that have convened over the past three years in the US have set a powerful collaborative precedent, but internal strife will quickly turn to public misunderstanding if quicker progress cannot be made locally now that we have representation at the most influential health care policy-writing entity in the world.  In summary, we must emphasize those priorities which hold the most gravity as well as the most promise; this internship is clearly one of them.  Several outcomes will need to be met to ensure that this internship program makes the impact it is designed for:

(1) Chiropractic colleges in cooperation with licensing and accrediting bodies will need to better promote participation in the internship.  The most educated, poised and influential chiropractic students in the world will have to be given an incentive to participate without having to sacrifice their educations.

(2) Chiropractic professional associations must promote the importance of participation and support the endeavor both financially and organizationally.  These groups’ captive audiences make them the ideal soapbox for touting a tangible means for creating inter-professional unity.

(3) Students must have the desire to participate and be encouraged to do so.  The power of organizations such as the Student American Chiropractic Association and the World Congress of Chiropractic Students, to name two, lies in their ability to rally potential leaders and create a pathway to realize their potentials; but students must actively seek out these opportunities.

One of my mentors once told me that to make a big difference one need only start by taking small steps in the right direction.  Although performing these critical appraisal activities may seem like a relatively insignificant step, this in concert with the amazing work done by previous interns Drs. Molly Robinson and Jennifer Nash will no doubt have lasting effects.

For those of you who are new to the blog, I am a 4th-year doctor of chiropractic student from Southern California who is interning in the Department of Essential Medicines and Pharmaceutical Policies at the World Health Organization headquarters in Geneva.  My responsibilities are to perform critical appraisal and peer-review activities for documents pertinent to the proliferation of Complimentary and Alternative and/or Traditional Medicines (CAM/TM) worldwide.  I am currently studying a host of documents including the WHO Traditional Medicine Strategy 2002-2005, The National Policy on Traditional Medicine and Regulation of Herbal Medicines and the WHO Guidelines on Basic Training and Safety in both Chiropractic and Acupuncture in preparation to develop a systematic review on available literature discussing the integration, safety, efficacy, quality, accessibility and rational use of chiropractic and TM as a whole in global healthcare systems.

As a chiropractic student, it is often difficult to reconcile my place in a department weighted by an emphasis on Traditional Chinese Medicine, however, I cannot help but see how such a popular phenomenon with a nearly-3,000-year-old history can glean powerful information about steps my own profession can take to achieve full-scope integration and global notoriety.  I am reminded that although I frequently view health care through chiropractic-colored lenses, most vitalistic media share common methods, principles and outcomes.   In fact, research has shown that patients tend to view all CAM/TM modalities in the same way, as all-encompassing foils to allopathic medicine.  In the context of the United States, where allopathic medicine dominates and no official government-sponsored CAM policy exists, patients are just now beginning to see benefits in CAM techniques that already hold as much as an 80% market share of the healthcare economy in some developing countries.

The US tends to mirror most other developed countries in it’s mass-appreciation for paradigmatically new phenomena such as CAM/TM, in that its citizens share similar belief systems.  Popular techniques such as acupuncture, for example seem to be growing in popularity for several common reasons: concern about the adverse effects of chemical drugs, questioning of the approaches and assumptions of allopathic medicine and greater public access to health information.  An increasingly aging population also adds momentum.  The current renaissance in chiropractic can surely be attributed to similar driving societal factors, but carries with it a special weight because it traditionally does not incorporate the use of herbs, nutraceuticals or supplements as some of the other included CAM/TM modalities do.  In fact, much of the literature evaluating CAM/TM only includes scant passages about chiropractic because, it seems it requires less critical critique in terms of safety evaluation and regulation.  Case-in-point, chiropractic care is much simpler and significantly less invasive than the dominant CAM modalities worldwide, although we have seen major problems in countries without official policy statements on chiropractic including the proliferation of what I like to call faux-chiropractic which is performed by non-certified practitioners.

The chances are good that as my research progresses, the need for expanded access to chiropractic will become apparent, especially amongst the poorest populations globally.  For a profession caught up in the recent CAM whirlwind, it behooves us to embrace the growing positive public perception of what we do in collaboration with other CAM/TM techniques to reap the common benefits for ourselves and, most importantly, our patients.