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Chiropractic Journal of Australia : CJA March 2012
12 Chiropractic Journal of Australia Volume 42 Number 1 March 2012 THE CROSSROAD Any decisions we may make surrounding Villanueva- Russell’s fve domains are inextricably linked to the single fundamental choice we make regarding where we place ourselves along an identity spectrum long-term. Will chiropractic forge greater mainstream positioning using the most effective models of care or remain politically unconditional toward a singular identity of subluxation-care under a generalist model? Will we choose to maintain an unconditional focus on one singular vitalistic identity with an ever-expanding diversity and still expect we can ever earn a place at the mainstream table? How long will it take a generalist model of care to overcome the enormous challenge of demonstrating a predicable and measurable contribution to wellness that is limited to the application of one single method of care (adjustment) that is directed toward correcting a loosely defned entity (subluxation) that is yet to be recognised in mainstream public health policy? History does document that we have not and would not be integrated as equals if we expected to walk straight into the mainstream under a generalist model of subluxation- care. Both the medical gatekeeper and the evidence-based standards of care that are applied to all allied-health professions are well entrenched. Our hopes for fundamental changes to mainstream healthcare or the dominance of medicine is not about to change quickly in this process. The question becomes whether political chiropractic will take the small but necessary political steps that will initially engage our profession within this more collaborative and integrative mainstream setting? Alternatively, we might ask how much is chiropractic managing a major paradigm shift to date living largely on the mainstream edge? Greater collaboration does not appear to be failing other allied-professions currently seated at the mainstream table. Indeed, could taking these formal yet more conditional mainstream steps be the thin end of the wedge for chiropractic’s wider aspirations long-term. The World Federation of Chiropractic provides that regardless of the challenges, chiropractic must strengthen its commitment toward collaboration with other health professions.20 I believe our success in this regard is vital or chiropractic will slowly perish. This objective will require a stronger focus on the most useful evidence-based models of care while other models of care are under construction. It may strengthen our access to greater third-party cover including EPC, motor accident, workers compensation and health-funds. It may assist in our access to massive government research funding found inside the mainstream system through the National Health and Medical Research Council (NHMRC). We have historically described this as a ‘medicalisation’ or ‘allopathic’ threat to the vitalistic-model of chiropractic care. A collaborative and integrated approach toward the diagnosing, treating and viewing patient care from these mechanistic or outcome-oriented perspectives will ring alarm bells for some. This concern must be weighed up against the factors that contribute to why we are stalling at this time. A generalist-model has yet to form agreement on how to clinically classify subluxation, fnd subluxation or correct subluxation. The generalist subluxation-model has narrowed the harm of subluxation to a singular neurophysiology focus that is many years from reaching mainstream recognition or suffcient clinical evidence-based validity. This single focus has yet to deliver any real paradigm shift within society or within public health policy. THE SPINE-CARE MODEL WITH MANY SPECIALI- SATIONS A spine-care model for chiropractic beyond the current constraints and limitations of a generalist-model tackles billion dollar burdens on society, the government and insurance companies head on. Some sobering facts from the Australian Institute of Health and Welfare (AIHW)21 of just a few of the neuromusculoskeletal priorities where chiropractic has the opportunity for greater mainstream participation and strategic recognition: • More than 6 million Australians have arthritis or a musculoskeletal condition. • Back pain or disc-related disorders are the most common of musculoskeletal conditions, reported by more than 3 million Australians. • An estimated 690,000 Australians have osteoporosis, a large contributor to fractures in older persons. • Musculoskeletal conditions were the third most common reason for a person visiting a GP in 2007-08. • These conditions accounted for $4 billion or 7.5% of health system expenditure in 2004-05. • Arthritis and musculoskeletal conditions are the most common source of disability in Australia. • Early diagnosis and treatment can reduce symptoms and help to prevent damage to the joints due to arthritis. While this list is by no means complete, it begins to present a few examples where there is growing pressure on the government and health insurance sector to better deal with a range of neuromusculoskeletal disorders and where spine health is one of the greatest costs within it. Murphy, et al18 contest there is no other profession that can more powerfully build on our credentials with spine-care and spine health as our mainstream cultural authority. Why are chiropractic policy, vision and research not taking more advantage of a range of mainstream spine-based concerns? Could chiropractic be building on existing evidence, which demonstrates the clear relationship between poor spinal alignment and function – subluxation - and the massive costs from the associated disability, pain syndromes and degeneration, which are afflicting society today? Is our excessive and singular obsession with the neuroscience-model of subluxation-care taking suffcient advantage of tangible Government health priorities? The question is whether the chiropractic profession has an interest in harnessing this massive billion-dollar healthcare domain, one that may be our greatest strength. Are we willing to take the diffcult cultural and political steps that are necessary to reconcile our place within the existing mainstream healthcare framework if we are to achieve a mainstream role? Do grass roots chiropractors care enough to infuence this fate either way? Villanueva-Russell4 writes: STEERING THE CHIROPRACTIC MODEL MOORE
CJA June 2012