MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The World Federation of Chiropractic, Strategic Plan 2019-2022 has just been published. It is an odd document that holds many surprises. Sadly, none of them are positive.

As the efficacy and safety of chiropractic spinal manipulations, the hallmark treatment that close to 100% of all chiropractic patients receive, are more than a little doubtful, one would expect that such a strategy would focus on the promotion of rigorous clinical research to create more certainty in these two important areas. If you are like me and were hoping for a firm commitment to such activities, you will be harshly disappointed.

Already in the introduction, the WFC sets an entirely different agenda:

We believe that everyone deserves access to chiropractic. We believe in chiropractors being accessible throughout the world. We believe that societies can thrive where chiropractors are available as a part of people’s health care teams.

If you are not put off by such self-serving, nauseous nonsense and read on, you find what the WFC call the ‘FOUR STRATEGIC PILLARS’

  1. SUPPORT
  2. EMPOWERMENT
  3. PROMOTION
  4. ADVANCEMENT

The text supporting the first three pillars consists of insufferable platitudes, and I will therefore not burden you with it. But the title of No4 did raise my hopes of finding something along the lines of an advancement of the evidence-base of chiropractic. Sadly, this turned out to be over-optimistic. Here is the 4th pillar in its full beauty:

Advancing the chiropractic profession together under the banner of evidence-based, people-centered, interprofessional and collaborative care.

Around the world health is delivered according to prevailing societal, cultural and political factors. These social determinants mean that chiropractors must adapt to the environment in which they practice.

As a global federation we must continuously strive to advance awareness of chiropractic under a banner of ethical, evidence-based, people-centered care.

Through consensus-building, shared understanding and respectful dialogue with partners in the health system, chiropractic should become a valued partner in contributing enhanced population health.

Throughout our 7 world regions, we must advance public utilization of chiropractors to optimize the health of nations.

Through the identification of common values and a commitment to patient-centered care, we can advance the identity of chiropractors as spinal health care experts in the health care system.

The WFC will:

– Advance awareness of chiropractic among the general public, within health systems and among health professionals.

– Advance access to chiropractors for all people and broaden the integration of chiropractic services

– Advance interprofessional collaboration and the integration of chiropractic into health systems

_______________________________________________________________________

END OF QUOTE

The essence of the WFC strategy for the next 3 years thus seems to be as follows:

  1. Avoid any discussion about the lack of evidence of chiropractic.
  2. Promote chiropractic to the unsuspecting public at all cost.
  3. Make sure chiropractors’ cash flow is healthy.

There are some commentators on this blog who regularly try to make us believe that chiropractic is about to reform, leave obsolete concepts behind, and become a respectable, ethical and evidence-based healthcare profession. After reading the appalling drivel the WFC call their ‘strategic plan’, I am not optimistic that they are correct.

32 Responses to World Federation of Chiropractic, Strategic Plan 2019-2022

  • It seems to me that part of “Advancing the chiropractic profession together under the banner of evidence-based…care.” means they will be leaving obsolete concepts behind…that’s part of being evidence-based.

  • @ DC

    IMO, you’re deluding yourself. Here’s why:

    The World Federation of Chiropractic’s [WFC] Strategic Plan 2019-2022 states: “We respect diversity in the range of approaches that chiropractors take.” Its Secretary General, Richard Brown (former president of the British Chiropractic Association), takes things even further here:

    QUOTE
    “The WFC has unity as one of its core pillars. While it would seem very simple to cut adrift a section of the chiropractic community with whom we disagree, the reality is that this is neither possible nor desirable…The richness of the chiropractic profession lies in its diversity of approaches…Education is delivered differently. The philosophy of chiropractic care takes many forms, some aligned with other health professions, others quite distinct…The WFC values evidence-informed care and promotes research as a means of developing the chiropractic profession.”

    Ref: https://www.wfc.org/website/images/wfc/qwr/QWR_2017JUL.pdf (pp 5-6)

    That seems to be fair comment from him given that the June 2016 issue of the WFC’s quarterly journal carried a full-page promotion for a seminar which not only featured the notorious anti-vaxxer, Billy Demoss, but also promoted neo-vitalism and subluxation theory, practice, and correction. See p.13 here: https://www.wfc.org/website/images/wfc/qwr/QWR_2016B.pdf

    Further, the July 2018 issue of the same publication carried an advertisement for a detox product https://www.wfc.org/website/images/wfc/qwr/2018/QWR_2018JUL.pdf (p.23)

    …and the front cover of the October 2018 issue seemed happy to endorse the ‘adjustment’ of a camel: https://www.wfc.org/website/images/wfc/qwr/2018/QWR_2018OCT.pdf

    That October 2018 issue was preceded by the July 2018 issue in which the WFC president admitted that chiropractic reform had failed and that the profession was “now more diverse than it’s ever been” with chiropractors now practicing “in a range of different settings, using a wide range of interventions, and practicing from varying philosophical standpoints”
    Ref. https://www.wfc.org/website/images/wfc/qwr/2018/QWR_2018JUL.pdf (p.3)

    Bringing things up to date, in March of this year, the WFC partnered with the European Chiropractors Union [ECU – an autonomous organisation established by chiropractors and with no statutory powers] for an ‘EPIC’ event https://tinyurl.com/yyz7423m and in doing so would have known that the ECU’s education arm accredits the subluxation-based McTimoney and Barcelona chiropractic colleges:
    http://www.cce-europe.org/accredited-institutions.html

    There was a damning, skeptical write up of the event beforehand:
    https://complementaryandalternative.wordpress.com/2019/03/18/world-federation-of-chiropractic-biennial-congress-epic2019-evidence-based-or-not/
    …and another one after it:
    https://edzardernst.com/2019/05/chiros-at-war/

    Both are well worth a read.

    The latest news is that the WFC has just replaced its President with a new one, Vivian Kil DC. She gave a lecture in Greece in 2015 in which she said:

    QUOTE
    “We need, at least to the outside, to act as one profession…the decade to come, 2015-2025, will be a pivotal one in our history. We need to step up to the challenge and work toward achieving our position as primary spine care specialist right now, or we will miss the boat. If we miss the boat, the nightmare has set in, and our profession may no longer have a reason to exist.”

    Ref. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685193/

    It certainly doesn’t look like there are any sweet dreams ahead.

    • BW….IMO, you’re deluding yourself.

      I fail to see how I am deluded. All I did is quote the WFC. They stated their goal is advance and promote an evidence-based model. Their last conference created quite a stir in the profession due to the stance some of the speakers took on the topic. It’s a process, time will tell if they stand behind their goals….but unity, never going to happen IMO.

      • DC wrote: “I fail to see how I am deluded.”

        @ DC

        You wrote: “It seems to me that part of “Advancing the chiropractic profession together under the banner of evidence-based…care” means they will be leaving obsolete concepts behind…that’s part of being evidence-based…time will tell if they stand behind their goals”

        How is it possible for the WFC to stand behind their goals when they have already admitted (via their Secretary-General) that the “reality” is that it is not “possible nor desirable” to “cut adrift a section of the chiropractic community” with whom they disagree? ‘Cut adrift’ means to separate or detach. Do you seriously believe that the WFC can leave “obsolete concepts behind” whilst still tolerating a sizeable community of chiroquacks? I think that this quote from 17 years ago pretty much sums up how the WFC will be viewed from here on in:

        “…we surely stick out like a sore thumb among professions which claim to be scientifically based by our unrelenting commitment to vitalism. So long as we propound the ‘one cause, one cure’ rhetoric of Innate, we should expect to be met by ridicule from the wider health science community. Chiropractors can’t have it both ways. Our theories cannot be both dogmatically held vitalistic constructs and be scientific at the same time.”

        Ref: Joseph Keating Jr, ‘The Meanings of Innate’, Journal of the Canadian Chiropractic Association, 46,1 (2002), p.10.

        IOW, the World Federation of Chiropractic appears to be confirming that it embraces double standards.

      • @DC

        I fail to see how I am deluded. All I did is quote the WFC. They stated their goal is advance and promote an evidence-based model.

        You’re not a stickler for detail, DC. What the WFC stated was

        The WFC values evidence-informed [my bold] care and promotes research as a means of developing the chiropractic profession.

        There’s a world of difference between “evidence-based” and the weaselly-worded “evidence-informed”, as I’m sure you already knew when you altered the words in your pasted text.

        • FO…i copied directly from Edzard post. If it was altered, he did it.

          • @DC

            I think this is an object lesson in the unreliability of electronic searching, copying and pasting — and of human memory. If you search Edzard’s post electronically, the expression “evidence-informed” appears nowhere in it. So if you’re certain you copied directly from the post at the head of this thread you can’t have copied “evidence-informed”. 🙂

            The quotation “The WFC values evidence-informed care and promotes research as a means of developing the chiropractic profession and improving patient care and outcomes.” in fact comes from the July 2017 issue of Quarterly World Report from the WFC, page 6, as correctly cited and linked to in Blue Wode’s comment of Wednesday 14 August 2019 at 20:47.

            So you didn’t need to implicate Edzard as the villain of the quotation, DC. You have correctly quoted from the original source, even though you apparently don’t remember doing so.

          • Frank, I really don’t know what you are going on about.

  • Hello, Edzard.

    As a layperson, I am hesitant to correct you but I think you may have misquoted the Strategic Plan.

    I think what it was supposed to say is, “As a global federation we must continuously strive to advance awareness of chiropractic under a banner of unethical, woo-based, wallet-centered care.”

    Despite the error, you’re still my hero.

  • to DC – what evidence base are you referring to? If chiropractic were to leave obsolete concepts behind there would be precious little left for them to do!

    Instead they are trying to insinuate themselves into areas where they are even less qualified than they are in MSK – e.g. primary care and paediatrics. With their ridiculous forays into homeopathy and acupuncture along with their abominable anti-vax culture, society would be best served if chiropractors all retrained as librarians or something useful.

    my local chiro proudly advertises the perfectly idiotic cranio-sacral therapy (apparently blissfully unaware of the fact that the cranial sutures fuse in adults and that CSF is immune to external manipulation.) She also offers correct the damage done to “all newborns by passing through the birth canal” by manipulating their spines within hours of birth and for weeks thereafter – it is a wonder indeed that humans managed to evolve this far without having invented chiropractic before only the last 100 years!
    But things can only get worse – she has now been joined in practice by of all things – a naturopath/chiro hybrid! No doubt we shall see all manner of wonderful things emanate from this “evidence based centre” from now on!

    • MT…to DC – what evidence base are you referring to? If chiropractic were to leave obsolete concepts behind there would be precious little left for them to do!

      Most chiropractors do such things as exercise, rehab, lifestyle modification, ergonomics, etc. The obsolete concept surrounds the so called subluxation and the effects of its removal.

      MT….my local chiro…

      Sure, there are chiropractors out there promoting such stuff. I debate/argue with them (less so now as it’s usually a fruitless and frustrating effort). So sure, call them out, know your state/providence rules on advertising. If they are in violation, report them. I do.

      • From the World Federation of Chiropractic Website (https://www.wfc.org/website/index.php?option=com_content&view=article&id=90&Itemid=110&lang=en)

        Definition of Chiropractic
        A health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal adjustment and other joint and soft-tissue manipulation.

        Is not spinal adjustment the correction of subluxation?

        • Subluxation, osteopathic lesion, somatic dysfunction, sprain/strain, biomechanical lesion, manipulable lesion, etc.

          Different professions have different names for it.

          • and which professions use these terms?
            I am a proper doctor [one that has gone to medical school] and know only sprain and strain, neither of which term I ever used as a synonym of chiropractic subluxation.

          • ee…I am a proper doctor [one that has gone to medical school] and know only sprain and strain, neither of which term I ever used as a synonym of chiropractic subluxation.

            so what? go back to the pre-1900 literature and see what was known at that time regarding the subject. The word stems from the Latin subluxationem and was initially coined in the 1680s. It was Smith, Langworthy, and Paxon in their 1906 chiropractic textbook that first used the word subluxation. DD Palmer in his later writings even wrote that the medical sprain/strain was the chiropractic subluxation.

          • I would advise patients to see doctors who do not rely on the ‘pre-1900 literature.

          • Ee…I would advise patients to see doctors who do not rely on the ‘pre-1900 literature.

            Duh. Unless of course they are discussing pre 1900 literature in order to provide context.

            Do try and keep up.

          • you were discussing obsolete stuff, not me

        • I was responding to Peter Dyson. You jumped in and appear to be lost.

          • Are you so insecure and so unhappy in your own skin you have to include a hurtful comment in every post?

            I used to find your posts amusing. I’ve come to find your arrogance repugnant. Please do better.

          • Ron. I have a project coming up that will require some attention so i need to bow out for a while. Hopefully your wounds will heal.

          • Exactly what I mean.

            I suppose I should understand, though. Those who have no solid foundation on which to base an argument often rely on these types of put downs and attacks to take their opponents’ eyes off the real argument.

            I guess it worked. I am now addressing the device rather than the argument.

            But for the record, your arguments are still grossly wrong, though.

            Peace out. 🙂

  • Vivian Kil (nominative determinism?), WCF President in 2015:
    “We need to step up to the challenge and work toward achieving our position as primary spine care specialist right now, or we will miss the boat. If we miss the boat, the nightmare has set in, and our profession may no longer have a reason to exist.”

    That quote is four years old now, but do I detect an air of hysteria?
    What, exactly, is ‘the challenge’, other than to demonstrate professional integrity – basing a career in healthcare on evidence, not belief.

    What if the boat is missed and chiropractic “no longer has a reason to exist”?

    The reason for chiropractic’s invention was because D D Palmer couldn’t get on in medicine. (He stated his system was based on principles “different from those of medicine”.)

    The reason for its promulgation was to satisfy the commercial objectives of D D and especially B J Palmer who set up schools to ‘educate and train’ others who could not enter medicine.

    The reason for its further widespread use was on account of many others realising they too could get away with the nonsense – and formal regulation of medical practice was in its infancy.

    The reason chiropractic has become more prevalent is on account of modern marketing methods, and the persistence of patient gullibility.

    Miss Kill – the boat sailed a long time ago, which is why so many of us are exasperated that instead of training in a recognised profession (medicine, surgery or physiotherapy, for those particularly attracted to the musculo-skeletal system), some intending practitioners seem content to stick with outmoded concepts, to ignore the evidence, and to take advantage of patients with limited critical thinking skills. That is unethical.

    Chiropractic was invented in ‘opposition’ to modern medicine as that profession was slowly developing (and which it continues to do).
    Doctors who think patients might benefit from manipulations of one kind or another refer their patients to physiotherapists or even osteopaths (less so in the UK).

    Chiropractic has been left behind.
    Bon voyage on the good ship Anachronism.

    • RR…What if the boat is missed and chiropractic “no longer has a reason to exist”?

      Then it will slowly fade away into the history books…and chiropractors will have no one to blame except themselves.

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