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National Association for Chiropractic Medicine

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The National Association for Chiropractic Medicine (NACM) was[1] a minority chiropractic association founded in 1984[2][3] that described itself as a "consumer advocacy association of chiropractors".[4] It openly rejected[5][6] some of the more controversial aspects of chiropractic, including a basic concept of chiropractic, vertebral subluxations as the cause of all diseases. It also sought to "reform the chiropractic profession away from a philosophical scope of practice and towards an applied science scope of practice."[7] It stated that it was "dedicated to bringing the scientific based practice of chiropractic into mainstream medicine"[8] and that its members "confine their scope of practice to scientific parameters and seek to make legitimate the utilization of professional manipulative procedures in mainstream health care delivery."[4] "While the NACM is focused on furthering the profession, its primary focus is on the rights and safety of the consumers."[8] The NACM was the object of much controversy and criticism from the rest of the profession. It quietly dropped out of sight and its demise apparently occurred sometime between May 30, 2008 and March 6, 2010.[1]

Background

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Representing a minority viewpoint among chiropractors that is shared by those known as reform chiropractors,[9][10][11][12] the NACM advocated a highly limited use of spinal manipulative procedures "only for the treatment of some neuromusculoskeletal conditions of musculoskeletal origin,"[4] for example the treatment of "sore backs and other musculo-skeletal problems."[13] By openly rejecting[5][6] some of the more controversial aspects of chiropractic, including a basic concept of chiropractic, vertebral subluxations as the cause of all diseases. NACM members claimed to receive mainstream approval[4] more so than practitioners of straight or mixing chiropractic.

The NACM was a private organization that accepted members by invitation only[4] and did not release membership data, however the neutral Agency for Healthcare Research and Quality and the antagonistic ICA estimated its membership to be in the low hundreds[14] or less.[15][16]

Groupings within the chiropractic profession have been studied and categorized in various ways and the placement of the NACM within that spectrum has been mentioned in the literature. A 2005 study made with support from the chiropractic community had this to say:

"At the risk of oversimplification, chiropractors can be viewed as falling into three groups based on their usage of evidence, diagnosis, and philosophy: evidence based chiropractors, traditional straight chiropractors, and super straight chiropractors. Evidence based chiropractors make use of the best available scientific literature and accumulated clinical knowledge to establish diagnosis, refer or co-manage when necessary, devise and revise treatment plans. The evidence based chiropractor would most closely align with the AACP."[17]

That statement referenced the NACM as a subgroup of evidence-based chiropractors:

"Another subgroup represented by the National Association for Chiropractic Medicine (NACM) takes a more narrow view. Whereas the AACP believes in a wide variety of treatment measures, the NACM restricts members to NMS conditions and manipulation by hand only."[17]

In 1998, the AMA's Council on Scientific Affairs used communications from NACM's vice-president as a basis for some of the content in their "Report 12".[18]

In 2002, the Journal of Controversial Medical Claims[19] published a paper submitted by the NACM entitled "NACM and its argument with mainstream chiropractic health care."[2] In 2005, chiropractic leader Anthony Rosner had some strong words for the paper:

"The history of anti-chiropractic invectives labeling the profession as "unscientific" unfortunately fills volumes, from the days of Morris Fischbein's crusades against chiropractic as editor of the Journal of the American Medical Association, to a mind-numbing invective published in 2002 by Timothy Mirtz which I have rebutted in considerable detail elsewhere."[20]

Position on spinal manipulation for children and adults

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In 2006 the Maryland Health Care Commission examined and briefly compared the positions of the three chiropractic groups "with policies on spinal manipulation services for children: American Chiropractic Association (ACA); International Chiropractor's Association (ICA – with its specialty department, The Council on Chiropractic Pediatrics; ); and National Association for Chiropractic Medicine (NACM)." It then noted that the NACM position differed from the positions of the other groups, both for adults and children:

"NACM differs from ACA and ICA not only in the chiropractic treatment of children, but in the treatment of adults as well. NACM emphatically renounces subluxation as the root of disease or even as a scientifically valid term or condition. Their members believe that spinal manipulation is only useful for affecting joint dysfunctional disorders that result from normal or excessive 'wear' on the joints. As such, they restrict their practices to the treatment of neuromusculoskeletal conditions and do not believe that DCs are sufficiently trained to serve as PCPs for either adults or children. The basis for NACM's position on children and spinal manipulation comes from the 1993 Report to the Committees on Armed Services and Appropriations -- CHAMPUS Chiropractic Demonstration.[21] In this demonstration, only children 16 years and older were eligible for participation 'based on review of chiropractic literature that efficacy of chiropractic treatment of young children had not been established and to present more risk than benefit.'"[22]

Opposition from chiropractic profession

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The NACM met with strong disapproval from the American Chiropractic Association (ACA),[23] the International Chiropractor's Association (ICA)[15][24][25] and other chiropractic organizations,[11] and sparked controversy within the chiropractic profession in 1986 by coming out in favor of chiropractors using pharmaceuticals.[26]

It was often the object of attack and comments in the magazine Dynamic Chiropractic, as a search of the website will show. In 2002, the Department of Veterans Affairs chose to add Charles DuVall Jr., DC, to the VA "Chiropractic Advisory Committee" to help institute chiropractic care for veterans.[27] At the time, DuVall was president of the NACM, board chairman of The National Council Against Health Fraud (NCAHF), and also the chiropractic member of the editorial group running the website Chirobase, a website skeptical of traditional chiropractic beliefs and practices. The website still promotes the reform position advocated by the NACM and contains a list of chiropractors it recommends. Dynamic Chiropractic showed its opposition to DuVall's appointment by calling for an organized attempt to remove DuVall from the committee,[28] and by creating a banner and button to use:

"We are asking every chiropractic association, college, company and individual that has a publication or website to add this banner on the front page of their publications, and on every page of their websites. To make it easy, we are offering the banner in various file types on our website at www.chiroweb.com/noduvall."[29]

It failed to have him removed, and his role and influence in getting legislation passed which gave chiropractors access to the VA system was singled out for commendation by James Edwards, DC:

"And finally, Charles DuVall Jr., DC, who also served on both VA committees. That's right, Chuck DuVall of NACM fame! While Dr. Duvall's committee appointment was opposed initially by both the ACA and Dynamic Chiropractic,3[30] my private conversations with him totally convinced me that he was much more interested in veterans than his own agenda or the agenda of his organization. As a result of those conversations, a "gentleman's agreement" was reached in that I would work to stop opposition to his appointment if Dr. DuVall would not do any media interviews while a member of the VA committee. While colleagues warned me that Dr. DuVall could not be trusted and would not keep the agreement, he did. More importantly, I want you to know that during the three-year advisory process, Dr. DuVall represented mainstream chiropractic admirably and voted with the majority each and every time."[31]

Demise

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The exact time and nature of the demise of the association is not published, but in the April 9, 2010 issue of Dynamic Chiropractic, the editorial staff wrote:

The National Association of Chiropractic Medicine (NACM) apparently no longer exists. Responding to an inquiry regarding the organization's status from another chiropractor, a March 6, 2010 e-mail sent by NACM's national executive director, Ronald Slaughter, DC, said it all: "All good things come to an end. We tried. We failed. Chiropractic is a 'failed' profession. ... As of press time, the NACM Web site (www.chiromed.org) is no longer accessible. Exactly how long the site has been down is anyone's guess. The last recorded existence of the site is May 30, 2008. Like the National Association of Chiropractic Medicine, it too has disappeared with little notice.[1]

Notes and references

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  1. ^ a b c "No More NACM." Dynamic Chiropractic. April 9, 2010
  2. ^ a b Mirtz TA, Long P, Dinehart A., Slaughter RL, DuVall Jr., CE, Bryson R, Kourmadas F., Campo J. NACM and its argument with mainstream chiropractic health care. Journal of Controversial Medical Claims, 2002;9(1):11-25. (Article summary)
  3. ^ Ronald Carter, DC, MA, Past President, Canadian Chiropractic Association. "Subluxation - the silent killer." J Can Chiropr Assoc 2000; 44(1)
  4. ^ a b c d e National Association for Chiropractic Medicine Official website, archived copy from May 30, 2008
  5. ^ a b Renouncement as a requirement of membership: "The first and foremost requirement for membership in the NACM is that a Doctor of Chiropractic Medicine renounce the chiropractic hypothesis and/or philosophy; that is, the tenets upon which their scope of practice is based. The original chiropractic hypothesis, stated simply, is that 'subluxation is the cause of dis-ease.'. ... Because the hypothesis has found no validity in universally accepted, peer-reviewed, published scientific journals, belief in the hypothesis, then, is essentially a theosophy. Science has not found any organ system pathology which 'adjustment' or 'manipulation' of spinal joint structures has effect; that is, no disease or 'dis-ease' process is affected."
  6. ^ a b Judy Foreman in Boston Globe: "The debate over subluxations has been so heated that, over a decade ago, chiropractor Ron Slaughter and like-minded souls founded their own group, the National Association for Chiropractic Medicine, to renounce what Slaughter calls 'the historical, philosophical hypothesis that subluxation is the cause of all disease, which it surely is not. Subluxation is a metaphysical disease. . .and consequently, chiropractic today is practically a religion."
  7. ^ History of the NACM
  8. ^ a b Maley, Patterson, Rice, Sanders. "Complementary and Alternative Medicine in Managed Care Organizations and Tricare." Archived 2005-03-24 at the Wayback Machine U.S. Army - Baylor University Graduate Program in Health Care Administration, 2004
  9. ^ NACM's use of the term "reform" is found in their "History" statement.
  10. ^ "The Skeptical Inquirer magazine blasts chiropractic as unscientific 'societal problem'". The Chiropractic Journal. January 1988. Archived from the original on 2007-06-15. Retrieved 2007-06-07.
  11. ^ a b "Berkeley newsletter says: 'Be wary of chiropractors'". The Chiropractic Journal. October 1992. Archived from the original on 2007-06-15. Retrieved 2007-06-07.
  12. ^ William, Jarvis T (April 28, 2000). "Chiropractic: A Skeptical View". Retrieved 2007-06-07.
  13. ^ Foreman, Judy. "Chiropractic makes gains vs. skeptics". Boston Globe Online. 06/23/1997, p. C1.
  14. ^ "Chiropractic in the United States: Training, Practice, and Research." Dec. 1997. Research Summary. Agency for Health Care Policy and Research, Rockville, MD.
  15. ^ a b Letter from President of the ICA to the Managing Editor of The Wall Street Journal. International Chiropractors Association. November 19, 2002.
  16. ^ Mootz & Phillips Chiropractic Belief Systems Archived 2007-07-02 at the Wayback Machine: "However, both organizations [WCA & NACM] are proprietary (as opposed to being representative of their memberships) and have a very small number of members (believed to be in the low hundreds)."
  17. ^ a b "The Future of Chiropractic Revisited: 2005 to 2015." Archived 2007-07-10 at the Wayback Machine Institute for Alternative Futures, 2005.
  18. ^ Report 12 of the Council on Scientific Affairs (A-97). American Medical Association
  19. ^ Journal of Controversial Medical Claims. Aspen Publishers
  20. ^ Rosner "Exit, Pursued by a Bear." Dynamic Chiropractic, March 12, 2005, Volume 23, Issue 06.
  21. ^ CHAMPUS Chiropractic Demonstration, Aug 1993. Task III Report MRI Project No.8533-D, 1/24/86.
  22. ^ Annual Mandated Health Insurance Services Evaluation. Maryland Health Care Commission, January 19, 2006
  23. ^ "Veterans Secretary Appoints Chiropractic Advisory Committee." Archived 2007-09-27 at the Wayback Machine August 13, 2002. American Chiropractic Association
  24. ^ "Chiropractic Advisory Committee Named by U.S. Department of Veterans Affairs." International Chiropractors Association: "The inclusion of a representative from the National Association for Chiropractic Medicine is an unwelcome though not unexpected development, since the DVA had sought their participation from the very beginning of the discussion about possible legislation."
  25. ^ COCSA 'demands' ACA, ICA merger. Archived 2008-01-21 at the Wayback Machine The Chiropractic Journal, May 2007. Reporting an earlier motion by the ICA to support "...a profession-wide stand opposing the destructive efforts of the National Association for Chiropractic Medicine ..."
  26. ^ "NACM sparks national controversy: Association says chiropractic should use drugs" Archived 2007-03-11 at the Wayback Machine. The Chiropractic Journal. October, 1986.
  27. ^ VA Appoints Chiropractic Advisory Committee Archived 2010-05-28 at the Wayback Machine August 12, 2002
  28. ^ Donald Petersen, Jr, Editor. Let's Send a Message! Dynamic Chiropractic, September 24, 2002, Vol. 20, Issue 20
  29. ^ Donald Petersen, Jr, Editor. Let's Send a Message: No Charles DuVall in the VA Advisory Committee! Dynamic Chiropractic
  30. ^ Donald Petersen Jr, Editor. We're being played. Dynamic Chiropractic, Sept. 13, 2002
  31. ^ James Edwards, DC. The VA Committees: Mission Accomplished! Dynamic Chiropractic, January 15, 2006, Vol. 24, Issue 02
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