A University’s Struggle With Chiropractic
York University recently rejected a merger with a chiropractic college. The deliberation process leading up to this decision illustrates how susceptible universities can be to overtures by colleges of alternative medicine. Lessons learned from this situation may prove helpful for institutions facing similar temptations in the future.
“Senate’s approval in principle has been negated.” With these words on April 26, 2001, York University rejected an affiliation proposal with the Canadian Memorial Chiropractic College. The unfolding of the six-year deliberation process leading up to this announcement provides a good illustration of the current political climate within universities and the temptations they face. Since such pressures will only increase as the popularity of alternative medicine grows, it is important to chronicle York’s story and to reflect on the lessons that have been learned.
York University, located in Toronto, Ontario, is the third-largest university in Canada with over 1,000 faculty and an enrollment of 40,000 students. Though it has a relatively small science faculty-the Faculty of Pure and Applied Science (FPAS)-it has no medical school or large-scale health program.
The Canadian Memorial Chiropractic College (CMCC), also in Toronto, has about 100 faculty and admits about 160 new students annually into its four-year Doctor of Chiropractic (D.C.) program. The College was opened exactly fifty years to the day after D.D. Palmer, the founder of chiropractic, gave his first adjustment, and hence the “Memorial” in the College’s name. More than three-quarters of licensed chiropractors in Canada have graduated from CMCC (Kopansky-Giles and Papadopoulos, 1997) and less than 19 percent “rejects traditional chiropractic philosophy as espoused by D.D. and B.J. Palmer and emphasize the scientific validation of chiropractic concepts and methods” (Biggs, Hay, and Mierau 1997).
CMCC has sought affiliation with Canadian universities over a dozen times in its history (Brown 1996, 1994). Shortly after being rejected by the University of Victoria (British Columbia) in 1992, CMCC adopted a “revenue-neutral” model for attracting prospective partners, meaning that CMCC would remain fiscally separate from its university partner after the merger. York was among three Ontario universities that found this new approach appealing and in 1995 signed an agreement to enter into exclusive negotiations with CMCC. The basic understanding was that CMCC would provide a sum of $17 million (U.S.) for new buildings, infrastructure, etc., while York would mount some courses for chiropractic students and offer a D.C. degree.
Deliberation Prior to “Approval in Principle”
Thus began a seriously flawed, six-year adjudication process at York University that spanned two administrations and spawned numerous committees. Throughout this period, neither York’s administration nor its Senate expressed the slightest reservation that the pseudoscientific and antiscientific attitudes harbored by contemporary chiropractic and evident in CMCC’s curriculum would be legitimized by an affiliation, compromising York’s academic integrity. Moreover, they continually ignored pleas to solicit expert opinion from the external biomedical community on the grounds that York was entirely capable of dealing with this issue on its own, despite the fact that there were no experts on campus. An informed decision was particularly important in this instance because York was poised to become the first major university in the world to merge with a chiropractic college.
The first act of York’s then-Vice President of Academic Affairs was to create an internal six-member Task Force whose mandate was to advise the administration on the academic integrity of CMCC’s programs and curriculum and the opportunities for academic links between CMCC and York University. The fact that the Task Force Report strongly endorsed an affiliation and found no areas of concern for York’s integrity was not surprising: none of the Task Force members was an expert in chiropractic, and the most influential member, one of only two scientists and a distinguished biologist, had been advocating a closer relationship with CMCC for more than two decades. Even had members been aware that CMCC’s course descriptions referred to unscientific “subluxations,” that CMCC supported pediatric chiropractic that has been soundly condemned by the Canadian Pediatric Society, that CMCC officially advocated “choice” in immunization, that its curriculum emphasized chiropractic radiology, etc., it is unlikely the report would have turned out differently, as future events were to reveal. (For more details about difficulties with CMCC and contemporary chiropractic, see De Robertis et al. 1999, Barrett 1999, and Homola 2001.)
The way was now clear to draft an affiliation proposal that would come before the Senate in spring 1998 for “approval in principle.” Why was York’s senior administration so supportive of this proposal and confident of its merits? There are indications that it felt that a merger would make York an instant “player” in the burgeoning field of health-care policy in Canada, something considered important by influential social scientists on campus.
It is interesting to consider the reasons offered by York affiliation proponents at one time or another to justify their position:
- Chiropractic is a licensed, regulated profession in Ontario and as such there could be no question of its legitimacy as a university discipline.
- Chiropractic lacks a research maturity largely because the hegemonous medical establishment has marginalized it for years. As a result, chiropractic finds itself in a position analogous to conventional medicine a century ago.
- Chiropractic certainly needs some reforming, and the best way to do so-and the most socially responsible way-is to bring it within a university environment.
- Chiropractic works.
- The “buy-in” price of $17 million.
Each of these arguments is quite facile and easily refutable. The first was by far the most popular defense of this initiative. Few seem to recognize that licensure has little to do with scientific legitimacy or the ability to establish a research culture, the essential issues at hand for a major university. Massage therapy, for example, is licensed and regulated in Ontario, but no one has suggested offering a university degree in it; (b) is simply inaccurate, though it may sound convincing to some academics for whom everything is political. Chiropractic has remained on the margins by choice, refusing even today to reject vitalism in all its guises. And there is considerable doubt that a four-year university program culminating in a D.C. degree is necessary to treat musculoskeletal conditions, something conventional therapists do with comparable effectiveness but without the vitalistic baggage; (c) is entirely irresponsible until chiropractic renounces its antiscientific practices and attitudes of its own volition. Moreover, if social responsibility were the issue, a merger with an institution with a medical school would be far more appropriate; (d) there are no compelling studies that show that chiropractic therapies are safe and effective. Some may even be dangerous (e.g., Norris, Beletsky, and Nadareishvili 2000); (e) though fiscal pressures on universities may be enormous, is academic integrity for sale?
Scientists in FPAS reacted swiftly and proactively to the proposal. Prior to the Senate vote, FPAS formed a committee to investigate chiropractic and CMCC-to take its own look at the issues. The committee’s first act was to solicit advice from external biomedical experts. What it learned was so disturbing that the overwhelming majority of scientists formally voted to have no association with CMCC whatsoever a few weeks before the Senate vote was scheduled.
What transpired at the May 28, 1998, Senate meeting was a chilling reminder how tenuous truth’s foothold is within the contemporary university (De Robertis 1998). Not only were FPAS’s democratically expressed views ignored, but many senators took the opportunity to deliver flagrantly antiscience speeches while extolling the proposal. Scientists were repudiated for their adherence to “the truth” when there are clearly “many truths.” Being “grant-fixated” they were said to be incapable of recognizing that alternative medicine is the way of the future and that York should be a leader and not a follower; affiliating with CMCC would be the first step toward securing a medical school; Qi gong and chiropractic are important to help our dance students . . . and so on. Neither FPAS’s dean nor its senators countered any of this nonsense. Some science senators even apologized for FPAS’s vote. In the face of this tidal wave of irrationality, the Senate voted overwhelmingly to grant the proposal “approval in principle.”
Deliberations After “Approval in Principle”
Fortunately, this was not the end: “Approval in principle” is given to proposals in order to establish a more thorough and deliberate vetting process to be followed at a later time by a final vote in Senate. There was nothing thorough about what transpired, however.
It was during this period that a small group of faculty (three physical scientists and a psychologist), with advice from individual experts from the biomedical and scientific communities in the United States and Canada, mounted a coordinated campaign against the biased and uncritical process. The group’s chief demand was for equal time; since the university had solicited advice extensively from alternative medicine practitioners, it should offer the biomedical community a similar opportunity. How else could an informed decision be achieved?
Yet the administration and Senate ignored or refused all such requests. They never invited a single biomedical expert critical of chiropractic to testify on the merits of this proposal of their own volition and ignored the following compelling testimony provided in 1999-2000:
- a petition organized by the Council for Scientific Medicine whose signatories included two Nobel laureates in medicine that asked York not to proceed (www.csicop.org/articles/19990203-chiropractic/).
- a petition from 150 York faculty and graduate students asking for the university to reopen the process, this time soliciting evidence from the biomedical community.
- a letter from the Canadian Pediatric Society repudiating pediatric chiropractic and asking York not to legitimize it (www.ndir.com/chiro/cps.html).
- dozens of letters from prominent medical doctors, scientists, academics, and skeptics from around the world asking York to reconsider this proposal.
- full-page ads in the student newspaper from the “opposition,” drawing attention to the anti- and pseudoscience attitudes within contemporary chiropractic and present in CMCC’s curriculum, as well as serious flaws in the vetting process.
Why no York official felt compelled to address a single biomedical concern is a matter of some speculation. University officials may well have been confident that their support was deep enough that they could get away with ignoring scientific issues.
When FPAS rejected any association with CMCC, the university had to identify another host faculty if it wished to carry through with the proposal. Still strongly supportive, it chose Atkinson College, a Faculty of Liberal and Professional Studies, which had a small nursing program and which aspired to a School of Health Studies.
Atkinson unexpectedly showed little enthusiasm for this initiative. Its first committee established to consider whether to host CMCC issued a split report in June 2000. At that point, five years into the process, CMCC made it clear it was growing impatient. Within two months, another Atkinson committee was created whose mandate was to explore all possible relationships the two institutions might share. The composition of this committee illustrates how desperate things had become: of the six voting members, five were on record as having spoken favorably of the proposal. Of the six nonvoting members, five were chiropractic supporters, including two representatives from CMCC. (The full text of these and other relevant reports can be viewed at www.ndir.com/chiro/ chronology.html.)
While it came as no surprise that the committee report submitted in November 2000 favored a full affiliation, it was a major surprise that Atkinson’s faculty in March 2001 rejected any association with CMCC, thereby putting an end to this nightmare once and for all. York and CMCC agreed to go their separate ways.
Lessons Learned and the Future
In some ways, York University is atypical of major universities because of its lack of a medical school and relatively small science Faculty. But in many ways, the difficulties it faces are symptomatic of the times. With ever-shrinking budgets, university administrations are challenged more and more to devise creative ways of securing funding.
Enter alternative medicine, whose popularity with the public is growing rapidly. Colleges of acupuncture, homeopathy, and naturopathy have become ubiquitous in major centers, along with chiropractic colleges. Can there be any doubt that those with “deep pockets” will seek legitimization through affiliations with universities in the future? Interested university administrations will spin it differently. They will speak about the social responsibility of their institution both for improving the training and outlook of alternative practitioners and in demonstrating the safety and efficacy of the relevant therapies.
But this overlooks two very important points. Chiropractic proponents sometimes referred to a merger between York and CMCC as a “marriage,” while at the same time admitting that chiropractic needs to be reformed. Yet no counselor recommends marriage in order to change a partner. First change, then talk. In the same way, even if some alternative therapies are eventually found to be effective and safe, until colleges adopt contemporary biomedical paradigms instead of millennia-old vitalistic notions-i.e., get rid of the nonsense in their curricula and make an attempt to educate its practitioners-no university should contemplate an affiliation. Furthermore, contrary to arguments made by some sociologists, no university has a responsibility to take in an alternative medicine community simply because a significant minority of the population uses its therapies. Many adults believe in astrology, but university administrators wouldn't entertain a serious suggestion to merge with a school of astrology (one hopes).
Second, a responsible affiliation presupposes that relevant alternative therapies have been demonstrated to be safe and effective. Very few universities are capable on their own of assessing whether therapies are safe and effective. This is the responsibility of institutions with significant budgets and the will to carry out such tests like the National Center for Complementary and Alternative Medicine of the National Institutes of Health.
York’s administration won't be the last to contemplate seriously an affiliation with a college of alternative medicine. Based on the experience at York, the following insights might prove useful for another institution facing a similar situation.
- Scientists must become involved as early as possible in the process in order to impress upon the administration the importance of adhering to scientific, academic, and ethical integrity and to filter out the facile arguments of the type cited above. While it is necessary to have a core group of scientists leading the charge, it is equally important to obtain broad-based support from a number of departments and faculties, especially outside of science, in order to diminish the effectiveness of anti-science attacks. These supporters must include faculty administrators whose position must be made loud and clear. All participants, regardless of their position, should declare any conflict of interest at the outset, and benefits accruing to a department or faculty from a merger should be clearly identified.
- Always take the “high road.” Those for whom scientific integrity is secondary might reject the science faculty’s position if they perceive it has been made in an unscholarly or arrogant manner. For such faculty, it is particularly effective to identify violations of process. Such violations may be an indication that the administration has not thought things through properly, or may be hiding things. It might also help to point out to the community that such an affiliation effectively amounts to the “corporatization of the university.”
- It is important to introduce precedence into the conversation as early as possible. At York University, the more than a dozen previous affiliation attempts by CMCC were unknown to the community until well after “approval in principle” had been granted. If other institutions have turned down a similar affiliation in the past, why should your university even consider this proposal?
- Where an institution has no internal expertise in the area, both the alternative and conventional medical communities should be consulted. If the administration or faculty refuses, then it is up to the science faculty to press its case with all legal means at its disposal.
- Local and national medical associations should be pressed to provide clear statements on areas of concern about alternative medicine. Fearing legal consequences, most medical associations and conventional practitioners now appear to have adopted the “live and let live” approach when it comes to alternative medicine. Yet where biomedicine has serious evidence-based criticisms of an alternative therapy (e.g., pediatric chiropractic), it has a responsibility to alert the broader scientific community, politicians, and the public. It would be convenient if medical societies could provide regularly updated position papers on alternative therapies.
- Never give up! There are a couple of instances when things looked particularly bleak at York, but the sun always seemed to rise again. No single tactic won the battle. For this reason, it is important to mount a campaign that is broadly based. It is likely that you will receive strong support from many colleagues in private, but very few will stand at your side in public. And be prepared for scientists who will support the proposal, defying all logic. Scientists are as susceptible as anyone else to the temptations of politics.
Finally, it is important to view your own struggle in the broader context, as part of a much larger campaign in which all skeptics are called to participate. Cash-strapped, postsecondary institutions will continue to be wooed in the near future by alternative medicine: “Have money, seek legitimacy. Are you for sale?” And the moment the first university succumbs to this temptation, society will have taken a fork in the road that leads away from enlightenment.
- Barrett, Stephen. 1999. Evidence of unscientific teaching at CMCC. Available at www.chirobase.org/03Edu/york.html.
- Biggs, Leslie, David Hay, and Dale Mierau. 1997. Attitudes of Canadian chiropractors. Journal of the Canadian Chiropractic Association 41(3): 145-154.
- Brown, Douglas M. 1996. Journal of the Canadian Chiropractic Association 40(2):87-99.
- —. 1994. Journal of the Canadian Chiropractic Association 38(1):41-54.
- De Robertis, M., 1998. Concerns about Chiropractic at York University: Scientific Objections. Scientific Review of Alternative Medicine. 2(2):49-55.
- De Robertis, Michael, J. Alcock, D. Böhme, and S. Jeffers. 1999. Scientific objections to York-CMCC affiliation. Available at www.ndir.com/chiro/ scientific.html.
- Homola, Samuel. 2001. Chiropractic: Does the Bad Outweigh the Good? Skeptical Inquirer 25(1):50-53.
- Kopansky-Giles, Deborah, and Costa Papadopoulos. 1997. Profile of Canadian chiropractors. Journal of the Canadian Chiropractic Association 38(1):41-54.
- Norris, John, Vadim Beletsky, and Zurab G. Nadareishvili. 2000. The dangers of chiropractic neck manipulation. Canadian Medical Association Journal 163(1):38-40.