The National Association for Chiropractic Medicine (NACM) is a consumer advocacy association of chiropractors who confine their scope of practice to scientific parameters and seek to make legitimate the utilization of professional manipulative procedures in mainstream health care delivery. The NACM offers consumer assistance in finding member practitioners.

INTRODUCTION

The National Association for Chiropractic Medicine (NACM) was founded in consumer advocacy. Most professional associations are formed to further the interests of the professional individuals forming the organization. Members of the NACM believe that the interests of the public must come first over the interests of the professionals making up the association. Associate members believe that, in serving the public interest, they will be working toward a better profession, which, ultimately, will further their professional/personal goals.

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." Modern day chiropractic associations may have expanded and changed this simple statement for the public, but the reality is that this remains the backbone of chiropractic education and practice to this day. In clarification, the term "subluxation" has never been defined by the profession in a way as to have universal acceptance within the chiropractic profession. Chiropractic "subluxation" is not the same as medical subluxation, which represents a partial dislocation of joint structure and would be a contraindication to "adjusting" or "manipulating" the joint structures. Chiropractic "subluxation," not having universal definition, and, thereby, not having received universal scientific status of existence, has evolved into a metaphysical status. Further, the profession has neither defined nor outlined what disease or "dis-ease" that the correction of the "subluxation" might cure or affect. 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.

For these reasons, members of the NACM renounce the chiropractic hypothesis as a basis for their scope of practice. NACM members accept the scientific fact that "manipulative procedures" ("adjusting" spinal segments) has scientific validity simply for affecting joint dysfunctional disorders. NACM members confine their scope of practice to the treatment of joint dysfunctional disorders, which include the biomechanics of the human frame, posture, weight bearing and gait, and the pain or discomfort concomitant with this dysfunction which may result in excessive "wear" of these joint structures. NACM members do not consider themselves to be an "alternative" to scientific medical care and attempt to work closely with medical/osteopathic professionals. NACM members do not consider themselves to be "primary care" practitioners, as this would necessitate the training and ability to therapeutically impact any health care need of the consumer. NACM does not believe chiropractic education nor license to practice encompasses this scope of practice. NACM membership practitioners are "portal of entry" doctors, in that the consumer does not need referral from any other type of health care professional.

Because of these requirements, member Doctors of Chiropractic Medicine of the NACM have been recognized and recommended by professional associations and consumer magazines/periodicals, some of which are listed below:

• American Medical Association, Reader's Guide to Alternative Health Methods, Feb. 1993. This handbook states: "Provides referrals to scientifically-oriented chiropractors for treatment or insurance claim reviews. Its members limit their practice to musculoskeletal problems and have denounced unscientific methods used by many of their colleagues. The group's application form includes a pledge to "openly renounce the historical chiropractic philosophical concept that subluxation is the cause of disease."

• The National Council Against Health Fraud, Position Paper on Chiropractic, published Feb. 14, 1985. The NCAHF address is Box 1276, Loma Linda, CA 92354. Telephone (714) 796-3067.

• "Chiropractors: Can They Help? Do They Harm?" Consumer Reports, June 1994, Pages 383-390.

• "Where to Find Real Back-Pain Relief." Consumers Digest. July/August 1994, Page 29-32, 72-73, authored by Sherry Helms.

• Prevention's Health Resource Guide , June, 1994.

• Begley, Sharon. "The Health News Your Doctor Won't Tell You: Alternative treatments that work." McCall's, Oct. 1994, Pages 52-63.

• Harris, Marilys. "The Well Adjusted Child." Woman's Day, June, 1995, Pages 77-80.

• Harvard Woman's Health Watch, Complementary Medicine, Chiropractic Manipulation, Dec. 1995.

• Protos, John. "Ten Things Your Chiropractor Won't Tell You." Smart Money, Pages 107-113.

• Gilbert, Susan. "What Chiropractors Are Really Good At...and which problems you should never put in their hands." Remedy, Pages 22-25.

• The Health Robbers, A Close Look at Quackery in America, edited by Stephen Barrett, M. D., and William T. Jarvis, Ph.D., published in 1993 by Prometheus Books, 59 John Glenn Drive, Buffalo, New York 14228-2197. These authors state on page 167, "In 1984, some clear-thinking chiropractors formed the National Association for Chiropractic Medicine with hopes that they could help place chiropractic on a sound, scientific basis." On page 190 they state, "My observations suggest that consumers should be wary of chiropractors, except for the few who belong to the National Association for Chiropractic Medicine."

• Magner, George. Chiropractic: The Victim's Perspective. Prometheus Books, 59 John Glenn Drive, Amherst, New York 14228-2197, Pages 21, 94, 193, 199, 212.

• Victims of Chiropractic of Orange County, CA., P. O. Box 3962, Huntington Beach, CA 92605, phone 714-841-8625, Director, Don Paulin.

• Federal Express Newsletter, "Chiropractors in a New Light." Spring, 1997, p. 7, Federal Express Corp., P.O. Box 727, Memphis, TN 38194-9320.

Our Mission

"DEDICATED TO BRINGING PROFESSIONAL MANIPULATIVE PROCEDURES INTO MAINSTREAM HEALTHCARE DELIVERY"

POLICY STATEMENT

What is the National Association for Chiropractic Medicine (NACM)?

• The NACM is a professional organization of chiropractic physicians who are dedicated to the scientific advancement and understanding of physical medicine, spinal manipulation, and consumer advocacy.

Who are the members of the NACM?

• Members of the NACM are licensed chiropractic physicians who understand the value of properly utilized spinal manipulative procedures in the management of neuromusculoskeletal disorders and confine their practice to these conditions.

What is the purpose of the NACM?

• The main purpose of the NACM is to further the understanding of spinal manipulative procedures in health care delivery.

Is the NACM politically motivated or directed?

• The intent of the NACM is to educate the chiropractor and protect the consumer.

How does the NACM recruit its membership?

• By invitation only.

What is the relationship between the NACM and the AMA, AOA, and medical or osteopathic society or orthopractic?

• There is none.

What is the NACM position regarding:

• Manipulative techniques? The NACM recognizes only those manipulative procedures proven therapeutically valid.

• Practice management? The NACM does not endorse any practice management company.

• Subspecialties of chiropractic? While there may be voluntary restriction of practice and/or concentrated study of a neuromusculoskeletal area such as orthopedics, neurology or sports medicine, these should not be interpreted as equivalent to subspecialties in medicine.

What is the NACM position on ancillary physical modalities?

• There are no peer-reviewed or published literature to prove the therapeutic benefit of passive physical therapy modalities.

What is the benefit to chiropractors for joining the NACM?

• Chiropractors joining the NACM will affiliate with like-minded physicians committed to the achievement of the highest levels of academic and professional excellence. The NACM is the only chiropractic organization recommended to the public and to the insurance industry by the American Medical Association and the National Council Against Health Fraud as well as many other published consumer articles on chiropractic practice. The NACM provides the consumer with an answer service to inquiry and a referral service to our membership.

How is the NACM funded?

• The NACM is funded solely from membership dues, educational programs and donations.

What type of continuing education does the NACM recommend for members?

• That which is scientifically valid.

Is the NACM a corporation and is it profit or non-profit?

• The NACM is a registered, non-profit corporation chartered in Texas.

Are NACM members permitted to have duel membership in other organizations?

• The NACM takes no position relative to members' political, religious, professional or social affiliations or memberships as long as such does not besmirch the credibility or ethics of the NACM.. The NACM is a consumer protection/education-based organization and is not a fraternal or political organization.

What is the scope of practice of an NACM chiropractic member?

• Members voluntarily restrict their practice to neuromusculoskeletal conditions.

What is the NACM position on the treatment of children?

• It is the opinion of the NACM that all individuals under twelve (12) years of age should be seen only in conjunction with a licensed medical\osteopathic pediatrician.

Does the NACM have a policy statement for the insurance industry?

Yes, as follows:

• The following position on spinal manipulative procedures, as it is related to the area of physical medicine and rehabilitation, is the consensus opinion of the Executive Board\Directors and Officers of the National Association for Chiropractic Medicine.

• Under the terms of contractual agreement, the insuring company is obligated to pay only those covered medical expenses which are:

1. reasonable and necessary

2. scientifically valid as universally accepted by the medical scientific community

3. recognized as being medically necessary for the diagnosed condition(s).

• Parameters of treatment and what constitutes "reasonable and necessary" treatment in the area of physical medicine in general and manual medicine in particular, is based on recent medical studies(1,2,3,4,5). This data is specific as to the efficacy/therapeutic benefit of spinal manipulative procedures, and the following constitute "reasonable and necessary" treatment in this area of physical medicine.

1. Spinal manipulative procedures are recognized only for the treatment of some neuromusculoskeletal conditions of musculoskeletal origin.

2. Spinal manipulative procedures are not generally accepted for the treatment of children under six (6) years of age.

3. Spinal manipulative procedures have not been proven to be of therapeutic value for chronic conditions or prolonged/protracted protocol of treatment.

4. Spinal manipulative procedures or the manipulation of any of the articulations of the human body shall be by hand only and may not be done by machines or mechanical devices.

5. Spinal manipulative procedures are known to be first diagnostic and then may be therapeutic. It has been found that there should be documented subjective and objective improvement in four to six weeks and/or eight to twelve treatment sessions. If no improvement occurs within this time frame, all treatment should cease for reassessment and consultation with an appropriate medical specialist. A treatment protocol should clearly be established based on physical examination findings, subjective response, judicious re-evaluation and this should be documented in daily treatment assessment notes made by the attending physician.

CURRENT LIST OF RECENT SCIENTIFIC STUDIES

SPINAL MANIPULATIVE PROCEDURES

The Appropriateness of Spinal Manipulation for Low Back Pain, (RAND, 1991)

Report to the Committees on Armed Services and Appropriations. CHAMPUS Chiropractic Demonstration, prepared by the Office of the Assistant Secretary of Defense for Health Affairs. (Dec. 1993).

Clinical Guideline - No. 14 - Acute Low Back Problems in Adults: Assessment and Treatment, U.S. Department of Health and Human Service Agency for Health Care Policy and Research. (Dec. 1994).

Monograph of the Quebec Task Force, Whiplash - Associated Disorders. (April 1995)

What the Scientific Literature Tells Us About the Use of Spinal Manipulative Therapy for Back and Neck Pain. (Harvard Symposium on Alternative Medicine, April 1995)

Chiropractic Services in a Staff Model HMO, Utilization and Satisfaction. HMO Practice, March 1997, Vol. II, Number 1, pg. 39-42, by John P. Hansen, M.D., M.S.P.H. and Daniel B. Futch, D.C., M.P.S.

1997 Wiley Expert Witness Update, New Developments in Personal Injury Litigation, Chapter 2, Chiropractic Medicine: Myth, Reality, and the Expert Witness. Charles E. DuVall, Jr., Wiley Law Publications, John Wiley & Sons, Inc.

Web-Related Resources

1. World-Wide Medical Search

2. NCAHF - National Council Against Health Fraud

3. Quackwatch - A Guide to Health Fraud, Quackery, and Intelligent Decisionmaking

4. Chirobase - A Skeptical Guide to Chiropractic History, Theories, and Current Practices

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If you have questions about NACM or you would like for us to contact you, please e-mail us at: ronlslaughter@hotmail.com