Testimony Of the American Chiropractic Association Before the White House Commission on Complementary and Alternative Medicine Policy Town Hall Meeting


White House Commission on Complementary and Alternative Medicine Policy


Testimony Of the American Chiropractic Association Before the White House Commission on Complementary and Alternative Medicine Policy Town Hall Meeting

September 8, 2000

San Francisco, California

Good Afternoon, my name is Craig Little, I am a doctor of chiropractic practicing in Hanford, California. I am representing the views of the American Chiropractic Association and will address three of the four focus areas of today's town hall meeting; Coordinated Research and Development to Increase Knowledge of Complementary and Alternative Medicine Practices and Interventions; Guidance for Access to, Deliver of, and Reimbursement for Complementary and Alternative Medicine Practices and Interventions; and Training, Education, Certification, Licensure, and Accountability of Health Care Practitioners in Complementary and Alternative Medicine.

Before I address these issues, I would like to express my disappointment at the lack of representation on this commission from the complementary and alternative health care community. Although I respect the experience each of you has in the area of complimentary and alternative health, the ACA questions how any meaningful dialog and recommendations can be developed without adequate input from the CAM community. I would appreciate any discussion on the rationale behind the decision to limit the representation of non-MD CAM providers on this prestigious committee.

Coordinated Research and Development To Increase Knowledge of Complementary and Alternative Medicine Practices and Interventions.
Everyone will agree that research on the efficacy on complementary and alternative medicine practices must continue. In addition, as CAM research continues to gain importance, it is imperative that the CAM practitioners be involved in all phases of research. The ACA would like to highlight four key areas that the Commission needs to address/discuss in the area of CAM research:

  1. Development of a data bank of research currently being conducted.
    This commission should not attempt to reinvent the wheel. There is a host of research currently being conducted that should be collected and provided to the public. From government pilot programs to insurance groups and medical university studies, CAM research is being conducted. But to my knowledge there is no one place that all the information is gathered. For example, on chiropractic issues, the U.S. Department of Defense recently concluded a five-year pilot study on the advisability and feasibility of integrating chiropractic into the military health care system. This pilot program showed that the use of chiropractic increased military readiness and saved the military significant health care dollars. As positive as this study is, it has not been made readily available to the public. All the various studies whether publicly or privately sponsored need to be collected and reviewed to reveal where additional research is needed. The ACA would suggest that the National Institute of Health National Center For Complementary and Alternative Medicine (NIH NCCAM) be the coordinator of this type of data bank.

  2. Relax federal statutory requirements that impede the use of proven CAM's in federal health care programs.
    Currently, many federal programs do not reimburse for complimentary and alternative treatments. These statutory limitations are impeding research by not allowing CAM practitioners to participate in federally sponsored coordinated care efforts. In addition, Doctors of Chiropractic and other CAM practitioners are further impeded by statute from providing their services to the general public through the federal student loan repayment program. By not being recognized as providers under these programs, doctors of chiropractic as well as other CAM providers are not provided the opportunity to prove the cost-effectiveness and efficacy of their services. Statutes must be changed to allow for all proven CAM providers to participate in all federal programs.

  3. Coordinate research wit the National Institute of Health's National Center for Complementary and Alternative Medicine.
    Research in the area of complementary and alternative medicine has been suppressed for many years. Therefore, the NIH NCCAM needs to continue to receive increased funding to ensure the continued research of complementary and alternative medicine. Although the NCCAM budget has increased over the years, its budget still pales in comparison to other institutes and centers at NIH.

  4. Provide incentives for private industry to invest in CAM research.
    The Commission should invite all groups involved in CAM research to identify the types of incentives they need to continue CAM research. The ACA would be happy to supply the Commission with a list of those companies that have contacted the association on research issues.
Guidance for Access To, Delivery of, and Reimbursement for Complementary and Alternative Medicine Practices and Interventions.
Patients should be afforded the availability to seek treatment by proven complimentary and alternative providers without the referral of a medical gatekeeper. In addition, both private and federal insurance programs should not limit a practitioners' scope of practice. Proven CAM practitioners must be recognized and reimbursed for all reasonable and necessary services provided to their patients. CAM providers should not be reimbursed at a lower rate or be discriminated against in any fashion based on their training or licensure.

Direct access must be provided to those CAM providers who possess diagnostic skills to differentiate health conditions that are amenable to their management from those conditions that require referral or co-management with other professionals. Doctors of Chiropractic recognize the value of working in cooperation with other health care practitioners, and acknowledge their responsibility to do so when it is in the best interest of the patient.

As mentioned above, Doctors of Chiropractic are currently excluded from participating in federal health care plans and are extremely limited in the scope of reimbursable services they can provide to Medicare beneficiaries. In its formal recommendations, the Commission must address these impediments to chiropractic so that all consumers can reap the benefits of chiropractic treatment.

Training, Education, Certification, Licensure, and Accountability of Health Care Practitioners in Complementary and Alternative Medicine
Providers of proven complementary and alternative medicine must be trained and educated at an accredited institution. In addition, state licensure should be considered to ensure that only trained and educated providers are treating the public. To create a better awareness of effective CAM practices, medical school students must be required to take a course on complementary and alternative treatments so that they are familiar with the alternative available to their patients. Students should also be encouraged throughout their schooling to refer their patients to complementary and alternative care providers when pursuing the overall care of their patients.

The Council on Chiropractic Education, through the U.S. Department of Education, accredits all chiropractic colleges. A chiropractic college curriculum consists of a minimum of four academic years of professional education averaging a total of 4822 hours. There are five curricular areas that are emphasized in chiropractic education; adjustive technique/spinal analysis, averaging 5555 hours of the clinical program, principles/practices of chiropractic, averaging 245 hours, and biomechanics, averaging 65 hours. Under the auspices of all chiropractic colleges, students are required to pass a practical examination on their manipulation skills and a clinical competency exam prior to internship. In addition, the chiropractic profession is held to rigorous skill testing for licensure. The principle-testing agency for the chiropractic profession is the National Board of Chiropractic Examiners. There are four parts to this examination: basic science, clinical subjects exam, written clinical competency examination, and special purposes examination for chiropractic. In addition, all states require a practical examination prior to licensure. This state licensing skill testing includes, diagnostic imaging, differential diagnosis, chiropractic technique and case management.

As mentioned above, currently there are very limited funds available to fund chiropractic/CAM educations. For example, the Public Health Service Act does not recognize Doctors of Chiropractic or other CAM providers to participate in this federal student loan repayment program. The Commission, in its formal recommendations must ensure that CAM students have access to federal funds, and federal repayment programs to assist in the repayment of their student loans.

Conclusion
Thank you for the opportunity to express the view of the American Chiropractic Association. I would be happy to answer any of your questions, and would also encourage you to contact the American Chiropractic Association on any chiropractic specific issues debated by this Commission.

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