 You're listening to This Week in Chiropractic. Here are the headlines for the week of February 2nd, 2021. The Texas Chiropractic Association announced a victory over the Texas Medical Association. The Supreme Court of Texas has ruled that the chiropractic scope of practice can include the Mescalo-Skeletal System, Sublexation Complex, and VONT. This brings an end to a 10-year battle between the associations, which hinged on the claim that neurological conditions were outside of the scope of practice. The full court opinion can be found in the show notes. Chiropractic economics projects decreased enrollment in chiropractic school during and after the pandemic. Data from the Chronicle of Higher Education show that more than a third of students are reconsidering and rolling in college due to the COVID pandemic. The number of chiropractors recommending chiropractic school to potential students has steadily declined over the past three years that CHIROECO has conducted their schools survey. In research, a paper published in chiropractic and manual therapies last week evaluated the adherence to radiographic guidelines for low back pain in two Canadian provinces. Half of the 53 participants stated they were aware of current radiographic guideline recommendations, and one-quarter of the participants indicated that they did not use guidelines to inform clinical decisions. From the conclusions, a small proportion still hold beliefs about radiographs for low back pain that are discordant with current radiographic guidelines, but the adherence rate to radiographic guidelines measured 75% using clinical vignettes. And the World Federation of Chiropractic has announced new members of their research committee. The appointments come months after the resignation of multiple members of the research committee last year. In their press release, the WFC states that the new research committee reflects the WFC's commitment to equity, diversity and inclusion, and is widely representative of geographic regions, culture and ethnicity, research background and specialty interests. The new committee consists of 13 members from seven countries, and all but one holds a Ph.D. Professor Christine Gertz continues as the chair. And those are your headlines for February 2, 2021. You can get links to all of these news articles, research articles and topics by going to the Twitch page at exploreandchiropractic.com. So again, just a quiet couple of weeks here, but the COVID news continues, and this one from ChiroEco is kind of interesting and not terribly surprising. I think they're projecting, they're kind of extrapolating here. This data comes from the Chronicle of Higher Education, which is a website that does publishes a lot of survey research. They look at universities, mainly undergraduate universities across the country and around the world, but they look at trends and publish some materials for professors and adjunct faculty to use. I've used some of it, it's quite expensive actually, which is surprising. But a lot of this is data about undergraduate schools. So 33% of students overall at universities are now reconsidering and rolling in college due to the COVID pandemic. I'm not sure how that works, if they're already at university, why are they reconsidering and rolling, unless they're just going to drop out? Maybe 43% of students are putting off starting one and two-year programs, while 66% of students are now considering different careers according to the study, the pandemic's impact on higher education marketing in 2020. A lot of this has to do with tuition battles, and so you've probably heard the stories of universities still charging tuition, even though students were not going to school, were not on campus, or maybe weren't even taking their classes. And so the Chronicle has noted that COVID-19 touched off a financial wildfire for colleges fanned by short-term losses and expenses, but fueled by the fundamental fiscal precarities that many institutions have been facing or failing to face for some time. Obviously, school has become very difficult, especially higher ed, and especially for chiropractic. I'll talk next week about a paper that I just saw today that didn't overview of how chiropractic schools have been adjusting and adapting to teach manual therapies. But the Chiropractic Economics article continues to talk about a survey they've been doing for three years in which more than 500 chiropractors respond to a series of questions about chiropractic school. They ask things like, would you recommend chiropractic to a potential student? Would you recommend the school that you went to? And I've found this information pretty interesting for a while now. It's gone down steadily from 80% in 2018, 2019 down to 77% now of chiropractors would recommend the profession to others. What is really surprising to me is the number of chiropractors who would recommend another school. They recommend the profession, but they recommend going to a different school than they went to. 81% in 2021 would recommend a different school. That just makes me think that people are not happy with the universities that they go to with chiropractic colleges that they go to. I feel the same way. I spent 10 years deciding which school to go to, and I was very confident that this was the school I wanted to, and I was disappointed. I don't think it's the schools. I think it's the chiropractic education in general. I think it needs an overhaul, it needs some improvement. We certainly need residencies. We certainly need better training on manual therapy, on manipulation, the adjustment, whatever. I'm reading Leonard Fay's book on the chiropractic odyssey, and of course the founder of Motion Paltation. He talks about this. He talks about the lack of evidence-based training on psychomotor skills and the manipulation, especially reviewing things. Orthopedic tests, special tests are the same in my opinion. 80% of chiropractors would say, yeah, of those who say do chiropractic would say, but go to a school that I didn't go to. I'd probably recommend CMCC, or I'd strongly consider schools like New York, and possibly even Palmer. Interesting to read through this of some of the statements, things that you've certainly heard before. The profession eats itself, never unified, never growing, and expanding its scope of practice. This person recommended to embrace functional medicine. Others say the ability to opt out of Medicare has not been addressed. Terrible student debt to income, no business classes, future of regulation are concerns. I recently got a survey from my alma mater from Western states, which include a bunch of these questions, kind of what range are you earning, how's the practice going, reflecting back on your education, what would you change. What was so interesting to me is that they had a question saying, what classes other than business should be offered, a complete admission that they do not teach sufficient business classes. Something from chiropractic economics, they say it's not just education, but all of chiropractic is having some issues, and that it's not just from COVID as well. The Texas Chiropractic Association has declared victory against the Texas Medical Association, so this is a lawsuit that's been ongoing. My understanding is the crux of it is that the medical board or the medical association in Texas has said chiropractors claim to treat neurological conditions, and they shouldn't. The medical association is saying that is not chiropractic practice, they should only be doing musculoskeletal. It even hinges around the sublexation complex, which is in, I believe it's in the Texas Chiropractic Board rules. And then VONT, and I don't remember what VONT is, I believe it's one of the common to the functional neurology treatments, but I might be mistaken, so please drop a comment below this video if that's something you're familiar with. I think this has a lot in common with the war on chiropractic, with the contain and eliminate the Wilkes trial back in the 60s, 70s. I think this, it's a victory, you know, I don't know, I worry about defining things like sublexation complex, but you know, in the end, the Supreme Court ruled that the challenge rules, the rules that the medical association were challenging in Texas, read in context, do not exceed the statutory scope of chiropractic practice. The fear here was that this would take away the ability of chiropractors to do basic, things that are basic to chiropractic, treating sciatica, radicular pain, that is neurological even though it stems from a physical biomechanical issue, but it would then limit their scope even beyond the so-called neurological conditions. So I think this is a good win. I worry that it's going to be, you know, taken out of context, but, and I would assume that this is where it ends, I doubt that they go to a higher court. I mean, the Supreme Court of Texas is the highest in the state, and I don't think that this is a federal issue. So good to see that this has resolved the entire opinion, which I have not yet read. It's 28 pages of legalese. Hopefully, I can read through that soon, but it is available, of course, public document, and so head to the show notes at exploringchiropractic.com to read that. The paper and the chiropractic manual therapies on adherence to radiographic guidelines. I chuckle because this has been such an issue lately, especially with the choosing wisely recommendations that ACA partnered with the American Board of Internal Medicine. And I just think, again, I've talked about this on different videos, there's so much misunderstanding about the role of radiographs of X-rays. And so it's interesting to see, okay, of chiropractors in Canada and these two provinces in Canada, with only 69 responding, how many of them actually follow these guidelines? And I was surprised, I was pleased, but then I was also a bit disappointed that a good amount of them are aware of the guidelines. Half of them are aware, but one quarter indicated they did not use the guidelines to inform clinical decisions. Now using the guidelines to inform clinical decisions doesn't mean you have to be strict and rigid about them. It doesn't mean that for every low back pain patient, you will not image them for six weeks. That's not what using the guidelines means. It means that you take into account the history, the presentation, the patient preferences, all of that and your clinical judgment, there are conditions, there are acute low back pain, which walk into the office and you think, ooh, this is not just normal acute low back pain. And that's fine then, the guidelines support getting imaging in that case. These guidelines aren't blanket statements. So I think it's misunderstood, which I wonder whether that's reflected in this. But I'm not surprised if chiropractors just throw out these guidelines and recommendations and say, I'm not paying attention to that at all. I'm just using my own clinical judgment. That doesn't surprise me either. But the adherence based on the clinical vignettes was 75%. So I think that's, if that's truly how many are adhering to the guidelines, then I think that's good. It's certainly better than the medical professionals, right? So many x-rays and MRIs that are just totally unneeded. So good paper from CMT and the World Federation. So again, I wish I knew more about what happened a few months ago. This certainly was after COVID because there are a couple of recommendations from the WFC research committee for chiropractors dealing with COVID that were written by Greg Kochuk and others who then resigned from the committee. And again, my understanding is that there was some concern about influence of corporate sponsors of the WFC, including perhaps a pharmaceutical. I might be completely wrong about that, but that's what I understand. And so it's really some great researchers that resigned from the committee. Now in February, the board has appointed other members, new members to the committee. And many of these are familiar. So Christine Gertz remains as current chair. Scott Haldeman is chair emeritus. Marc-André Blanchet in Canada, I'm not familiar with. He's at University of Quebec at Travair, which is the French-speaking chiropractic school in Canada. So I don't know anything about it. Dr. Michos, who used to be at Western States as the research chair there, and Jensen from Australia. Melissa Keough from Malaysia. It's awesome to see that we have a true representation of females and an international community of researchers. Although she is a PhD candidate, all but Michos have a PhD, if you consider the doctorate in philosophy as a PhD for Ann Jensen. Imran Khan from New Zealand. Kesari Padayachi from South Africa. Apologize if I'm butchering these. Steve Passmer from Canada. Katie Pullman in the US. Professor Sidney Rubenstein in the Netherlands. And Stacy Salisbury, who is a nurse, masters of nursing, has a PhD. And then Professor Michael Schneider, well-known researchers in the chiropractic world, many of whom are younger, a PhD candidate right now. I don't know if she's involved in Carl. That would be interesting. But this is promising. It was nice to have perhaps bigger names. I mean, you think of Craig Koch currently as one of the top chiropractic researchers, I guess. So a lot of these I'm not familiar with by name, but they are a bit younger, up-and-coming researchers. And so this is promising nearly half or female, probably not quite half, but at least a third, it looks like. I think that's great. I think this speaks to the addressing diversity. It speaks to representing different countries and different regions. So looking forward to see what comes out of this. The role of the committee is under the leadership of its chair, is to advise the board on matters of science and research and provide expertise in peer review and abstract selection at the biennial congresses. So they're not necessarily doing research for the WFC. They're not necessarily making statements or guidelines, but they play an important role. So that is it for this week in chiropractic. Again, these notes, these links to these articles and a couple of comments are available at exploringchiropractic.com. Look for the Twitch page. That's T-W-I-C-H. And you can follow me on Facebook, Instagram, Twitter. I'm on TikTok. I'm on LinkedIn. All of those at Exploring Chiropractic, except for LinkedIn, which is just my name, Nathan Cashin. I'm the host of the Exploring Chiropractic podcast, which hoping to get back up and running pretty soon. And I will see you again next week for more of Next Week in Chiropractic.