At the most recent ACC-RAC, FCLB and ACA House of Delegates conferences Perle specifically explored what he saw as financial pressure potentially surmounting whatever barriers some practitioner may erect for the protection of their own moral integrity. The need to respond to the demands of fiscal distress, he contends, can lead to the making of decisions that are only motivated by profit. However, the deliberate ignorance of the impropriety of one’s own actions, or even a process of rationalization (‘the insurance company is acting unreasonably with me so I will take advantage of them’) does not give a practitioner carte blanche to act in a manner they know is unethical (see also 15).
So perhaps herein lies the issue. In trying to decide whether the parsimonious or expansive view of chiropractic technique is more reasonable, our generalized limited (but growing) body of knowledge, as seen in all health care professions, is most inhibiting. While much is known about chiropractic efficacy and safety in general, little is known about the specifics of what technique works best for a particular condition. That said, this lack of knowledge cannot be used an excuse for the suspension of proper and appropriate ethical conduct in private practice.
Although it has become something of a cliché that extreme technique diversity hurts the profession, a point we do not question, we think the point is overdone. What is probably more harmful to the profession, and please forgive us for being blunt about it, is deliberate fraud. Some of this takes the form of dubious machines, subluxometers and the like, and some show up in the form of outlandish billings and utilization rates. We have seen very different products and techniques, as different from one another as can be imagined, unite when it comes to nefarious patient management schemes.
As previously mentioned regulatory agencies have one preeminent objective: to assure the public safety by attempting to ensure that all licensees maintain a minimal level of competency. Minimal standards do not mean that all aspects of practice need be homogenous, only that a lower level of homogeneity must exist. The desire to achieve clinical excellence is motivated by one’s moral compass; it is an ethical decision. Thus, the ethically motivated desire to maintain clinical excellence in concert with the heterogeneity of judgment and taste will still produce diversity within the profession that can be good as long as judgment is not clouded by deliberate ignorance or rationalization.
If the profession as a whole does not vigorously meet this most basic of professional requirements – self-regulation – the consequences could be dire. Currently, chiropractors enjoy what could be classified as “Group A” status in health care; that is, they are able to use the designation of ‘doctor’, to diagnose a patient and to provide patient care directly without medical supervision, not unlike dentists, psychologists and nurse practitioners. However if, as a profession, chiropractors do not limit their chimerical nature, whereby some members engage in either unethical behavior or bizarre practice activities that are so extreme that they defy logic or explanation, then chiropractors could, perceptually if not legally, be demoted to a ‘Group B’ status, lumped together with homeopaths, acupuncturists and massage therapists. The author from Ontario (Gleberzon) may be more sensitive to these concerns having seen the triple-whammy of the unsuccessful affiliation process with York University, disappointing recommendations from the Lewis Inquest and the delisting of chiropractic services from the Ontario Health Insurance Plan. That said, the chiropractic profession, in Canada, in the United States and worldwide, must be alert to the possibility that continued unchecked extremist chimerical behavior poses the real possibility that the body politic may develop the impression that chiropractic is not a real profession and that its’ members are not ‘real doctors’. That impression would be just as ostracizing to chiropractors, regardless of where they practice, as official demotion.