National Association for Chiropractic Medicine

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The National Association for Chiropractic Medicine (NACM) is a now defunct, minority chiropractic association founded in 1984[1][2] that describes itself as a "consumer advocacy association of chiropractors"[3] that seeks to "reform the chiropractic profession away from a philosophical scope of practice and towards an applied science scope of practice."[4] It states that it is "dedicated to bringing the scientific based practice of chiropractic into mainstream medicine"[5] 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."[3] "While the NACM is focused on furthering the profession, its primary focus is on the rights and safety of the consumers."[5] The NACM has been the object of much controversy and criticism from the rest of the profession.

Background

Representing a minority viewpoint among chiropractors that is shared by those known as reform chiropractors,[6][7][8][9] the NACM advocates a highly limited use of spinal manipulative procedures "only for the treatment of some neuromusculoskeletal conditions of musculoskeletal origin,"[3] for example the treatment of "sore backs and other musculo-skeletal problems."[10] By openly rejecting[11][12] some of the more controversial aspects of chiropractic, including the original chiropractic hypothesis that vertebral subluxations are the cause of all diseases,[13] NACM members claim to receive mainstream approval[3] more so than practitioners of straight or mixing chiropractic.

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."[14]

This 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."[14]

The NACM is a private organization that accepts members by invitation only[3] and does not release membership data, however the neutral Agency for Healthcare Research and Quality and the antagonistic ICA have estimated its membership to be in the low hundreds[15] or less.[16][17]

In 2002 the Journal of Controversial Medical Claims published a paper submitted by the NACM entitled "NACM and its argument with mainstream chiropractic health care."[1] 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."[18]

Position on spinal manipulation for children and adults

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 Chiropractors Association (ICA – with its specialty department, The Council on Chiropractic Pediatrics; members of the International Chiropractic Pediatric Association are a general sub-set of ICA); 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.[19] 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.'"[20]

Opposition from mainstream chiropractic profession

The NACM has met with strong disapproval from the American Chiropractic Association (ACA),[21] the International Chiropractors Association (ICA)[22][16][23] and other chiropractic organizations,[8] and sparked controversy within the chiropractic profession in 1986 by coming out in favor of chiropractors using pharmaceuticals.[24]

Notes and references

  1. ↑ 1.0 1.1 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)
  2. ↑ Ronald Carter, DC, MA, Past President, Canadian Chiropractic Association. "Subluxation - the silent killer." J Can Chiropr Assoc 2000; 44(1)
  3. ↑ 3.0 3.1 3.2 3.3 3.4 National Association for Chiropractic Medicine Official website
  4. ↑ History of the NACM
  5. ↑ 5.0 5.1 Maley, Patterson, Rice, Sanders. "Complementary and Alternative Medicine in Managed Care Organizations and Tricare." U.S. Army - Baylor University Graduate Program in Health Care Administration, 2004
  6. ↑ NACM's use of the term is found in their "History" statement.
  7. ↑ "The Skeptical Inquirer magazine blasts chiropractic as unscientific 'societal problem'". The Chiropractic Journal. January 1988. Retrieved 2007-06-07.
  8. ↑ 8.0 8.1 "Berkeley newsletter says: 'Be wary of chiropractors'". The Chiropractic Journal. October 1992. Retrieved 2007-06-07.
  9. ↑ William, Jarvis T (April 28, 2000). "Chiropractic: A Skeptical View". Retrieved 2007-06-07.
  10. ↑ Foreman, Judy. "Chiropractic makes gains vs. skeptics". Boston Globe Online. 06/23/1997, p. C1.
  11. ↑ 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."
  12. ↑ 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."
  13. ↑ Barrett, Stephen. "Chiropractic's Elusive 'Subluxation'". Quackwatch. December 25, 2001.
  14. ↑ 14.0 14.1 "The Future of Chiropractic Revisited: 2005 to 2015." Institute for Alternative Futures, 2005.
  15. ↑ "Chiropractic in the United States: Training, Practice, and Research." Dec. 1997. Research Summary. Agency for Health Care Policy and Research, Rockville, MD.
  16. ↑ 16.0 16.1 Letter from President of the ICA to the Managing Editor of The Wall Street Journal. International Chiropractors Association. November 19, 2002.
  17. ↑ Mootz & Phillips Chiropractic Belief Systems: "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)."
  18. ↑ Rosner "Exit, Pursued by a Bear." Dynamic Chiropractic, March 12, 2005, Volume 23, Issue 06.
  19. ↑ CHAMPUS Chiropractic Demonstration, Aug 1993. Task III Report MRI Project No.8533-D, 1/24/86.
  20. ↑ Annual Mandated Health Insurance Services Evaluation. Maryland Health Care Commission, January 19, 2006
  21. ↑ "Veterans Secretary Appoints Chiropractic Advisory Committee." August 13, 2002. American Chiropractic Association
  22. ↑ "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."
  23. ↑ COCSA 'demands' ACA, ICA merger. 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..."
  24. ↑ "NACM sparks national controversy: Association says chiropractic should use drugs". The Chiropractic Journal. October, 1986.

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