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July 2006, Vol. 16, No. 3

Table of Contents

Autism and Glutathione • CBP® Nonprofit has 24 publications in 12 months • CBP® Research Presented at the International Spine Conference in Norway • CBP® to File Lawsuit Against Quackwatch • CCE Weathers the Storm • Chiropractic Culture • Dr Don Harrison is ICA's Chiropractor of the Year • Dr Jim Gudgel to Co-Instruct With Neuromechanical Innovations • Dr Deed Harrison Speaks at Palmer West • Experimental or Medical Necessity • Fine Tune Patient Communication • From Screening to the Value of Proper Posture • ICA at the Table • ICA's Newly Elected Board Members • Instrument Adjusting's Mechanical Advantage • It's Don's Opinion • Letters to the Editor • My New Whiplash Text is Available • Patient Expectation and Retention • Principles, Ethics and Other Bygone Ideals • Problematic Decision Spectrum • Research Corner • Triano and CCGPP's Will Give You Six Visits

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CCE Weathers the Storm:

Gets re-approved

There were presentations for and against CCE at the June 6, 2006 meeting of the National Advisory Committee on Institutional Quality and Integrity (NACIQI). By the comments and questions from NACIQI Committee members, it appeared to attendees that the vote might be a very narrow 5 to 4 to re-affirm CCE as a nationally recognized accrediting agency for chiropractic. The actual vote was 7 to 2 to extend CCE for five more years. This was the first time that CCE was not unanimously approved.

              Unlike previous CCE presentations before NACIQI, which had been mostly complaints of a philosophical nature, this time the facts of Life’s accreditation fiasco were presented. As evidenced by questions from Committee members, the NACIQI Committee did not buy CCE’s brushing off of the Federal Judge’s decision against CCE and in Life’s favor.

              The 7 to 2 vote was taken following several hours of intense public testimony, the vast majority of which was highly critical of the operations, governance, and policies of the chiropractic accrediting body.

              USDE policy allows any member of the public to comment on the applications of accrediting agencies for federal recognition and sixteen organizations and individuals, including the International Chiropractors Association, took advantage of this opportunity to bring their issues and concerns before the federal advisory committee.  The CCE hearing gained national media attention with the prestigious Chronicle of Higher Education running a special feature report, stating that, “The public hearing at which the committee reached its decision on Tuesday (June 6, 2006) was one of the most contentious in years, according to veteran observers.”

              The concerns of the International Chiropractors Association (ICA) were presented by Dr. John Maltby, President and Dr. Stephen P. Welsh, ICA Board Member. Dr. Maltby and Dr. Welsh outlined before the USDE Advisory Committee concerns about CCE’s governance and the longstanding imbalance in the composition of the CCE Board and the CCE Commission on Accreditation, on which the conservative majority of chiropractic educational institutions has been consistently grossly underrepresented. Dr. Welsh related to the USDE Committee how the CCE has created a “self-perpetuating organization solidifying political control in the hands of and to the advantage of the minority,” to the disadvantage of the ICA affiliated schools.  

              As examples of the unrepresentative nature of CCE’s operations and structures, ICA submitted documentation showing that of the 19 individuals serving on CCE committees, only two were from conservative schools, and how one small educational institution had representatives on both the CCE Board and Commission on Accreditation at the same time. ICA also expressed grave concern over the lack of conservative representation on the all-important CCE “site visitation teams” through which the operations of accredited schools are reviewed and recommendations for changes made.

              ICA also expressed concern over the apparent failure of the CCE to follow its own rules over the years, resulting in a storm of controversy within the chiropractic profession, litigation and the erosion of confidence in the CCE within the chiropractic profession.

              Dr. Maltby and Dr. Welsh emphasized ICA’s position that the CCE was in urgent need of real reform, must meticulously follow its own rules, must provide for fair and balanced representation in all phases of its operations and that the historic imbalance and bias against the conservative schools who represent the majority of chiropractic students, must be corrected. 

              Dr. Joan Fallon appeared on behalf of the ICA Council on Chiropractic Pediatrics to address concerns over the very limited and insufficient pediatric educational component in current CCE standards. In her presentation, Dr. Fallon told the USDE Committee, “The CCE has tried in some ways to define chiropractic by what it deems important for the schools to teach. By ignoring pediatrics in the DC’s education, the CCE has failed to meet the essential needs of the practicing doctor of chiropractic. As a consequence, there is an extremely large hole in the educational fabric of the newly graduated doctor of chiropractic. It is critical that this hole be filled for the benefit of the doctor of chiropractic as well as the pediatric population.”

              Also expressing concerns about the CCE’s accountability, fairness and apparent conflict of interest issues were the Council of New Jersey Chiropractors, the World Chiropractic Alliance (WCA), the watchdog group Doctors for Excellence in Chiropractic Education (DECE), the Federation of Straight Chiropractors and Organizations (FSCO) and a number of individuals including former Life University President, Dr. Ben DeSpain, and a former Life University student speaking on the damage done to that community by CCE’s actions in 2002 revoking Life’s accreditation. While presentations were highly detailed, specific, well-documented and at times emotional, all of the speakers critical of CCE called for greater federal oversight of the accrediting body, but not for the complete withdrawal of federal recognition.

              Dr. Donald Hirsh of Laurel, Maryland speaking on behalf of Doctors for Excellence n Chiropractic Education (DECE), presented a series of points again focusing on fairness and apparent conflict of interest issues, as well as a strong emphasis for new attention to be paid on the activities of “site visitation teams”. Dr. Hirsh, on behalf of DECE, recommended “...that the USDE interview senior management personnel at each program regarding any evidence of site visitation teams pressuring the programs to make changes in their policies, curriculum, or procedures that are not found in CCE’s published standards.”

              Groups speaking in favor of the CCE were the National Board of Chiropractic Examiners, the Association of Chiropractic Colleges, the Federation of Chiropractic Licensing Boards and the American Chiropractic Association.

              CCE was represented by Dr. Joseph Brimhall, President of CCE’s Board of Directors, Martha S. O’Connor, Executive Director, Dr. Kathleen Galligan, Chair of the Commission on Accreditation and several attorneys and staff.

Members of the USDE Advisory Committee responded to the public testimony with dozens of insightful, searching questions and very quickly centered on the issue of the control of CCE’s governance. Four members of the Committee were especially concerned with apparent conflict of interest issues and the self-perpetuating nature of CCE’s governance, using the term “cartel” 17 times in their discussion.

              The philosophical nature of the divide within the profession was well recognized by Committee members and several articulated the fact that it was not the job of the USDE to sort out such issues. Many Committee members did grasp that in addition to the issue of philosophy, however, the behavior of the minority in control of CCE, able to act to their own advantage, was a cause for grave concern. Repeatedly using the term “doctrine” to describe the dominant position within the CCE, numerous Committee members spoke about the need for greater tolerance, openness and the accommodation of other viewpoints.

              On six separate occasions, reference was made by four different Committee members about the possible need for a second chiropractic accrediting body to serve the needs of a clearly divided profession. This repeated reference to the willingness of the USDE Committee to consider such a competing agency took all chiropractic representatives by surprise, but clearly showed the Committee’s concern for and awareness of the implications of a single, un-representative chiropractic accrediting body.

              Extensive discussion took place between Committee members and the representative from the National Board of Chiropractic Examiners on how graduates of colleges accredited by a federally recognized agency other than CCE would be treated in the examination process. Following several minutes of intense interchange, the NBCE representative did acknowledge that such graduates would be allowed to sit for exams but that the content of the tests could not be changed to accommodate them. It was following this exchange that the discussion of the possible “cartel” largely took place, with several members of the Committee noting how difficult it would be for a competing agency to effectively function in the current chiropractic environment, thus making the fair operation of the CCE even more important.

              In the closing minutes of the discussion among Committee members, Advisory Committee Chair Dr. Carol D’Amico asked CCE President Dr. Joseph Brimhall why those few groups speaking in favor of CCE did so with little enthusiasm, as if going through the motions, in contrast to the large number of critics, speaking with such passion. Dr. Brimhall simply responded by saying that he felt that those supporting CCE were credible and represented the majority in the profession.

What is Next for CCE: The Committee has made a recommendation to the US Secretary of Education to extend CCE’s recognition for a period of five years, with four specific areas of change identified by USDE as needing change. The Committee also adopted the staff recommendation that a report on reform progress be submitted to USDE by June, 2007. Ultimate action on this recommendation is in the hands of the Secretary.

              In recent years CCE has been at the center of a storm of controversy, even prior to its 2002 revocation of the accreditation of Life University’s chiropractic degree program. This decision was reversed by a federal court, the only such decision to be reversed by a federal district court in the history of higher education accreditation. In the subsequent years, CCE has been the target of a series of formal complaints, which resulted in the USDE finding CCE “not in compliance” with a number of the criteria required by the federal agency for recognition. This recent history has raised CCE’s profile and has focused scrutiny on its activities, and issues such as fairness and potential conflict of interest as never before.

              “ICA is looking for substantive reforms within the CCE, and believes that the ultimate survival of a sound system of chiropractic education in the US depends on it,” said ICA President Dr. John Maltby. “ICA was present at the USDE hearings out of a deep concern for chiropractic’s future and in the hope that such frank discussion will assist CCE decision makers in moving forward with the real reforms to which they have alluded. The CCE is facing unprecedented scrutiny, which will not end after these hearings. ICA is ready and willing to work on every possible level to assist CCE in this reform effort, but only time will tell.”

              The 7 to 2 vote must have been a sad moment for Dr. Sid Williams, as he sat silently observing the proceedings.

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