New Techniques and ETSDP rules

[Guest guest]

The OBCE in their considerable

collective wisdom went through many months of debate and thought about this question

of the development of chiropractic and how to set in place rules that would insure

public safety without unduly burdening the creative development of the

profession. I once made the statement that there is no chiropractic

technique now taught in chiropractic colleges that was ever developed in a chiropractic

college. All came from the field, and conversely, there are chiropractic

colleges that originated and grew out of development of particular techniques by

individual chiropractors in their practices. This is important to

remember. When I made this statement a couple of years ago in a post on

this board Dr. Phil made the claim that the Graston Technique was originated in

a chiropractic college, but this is untrue and it was originated by physical

therapists and co-opted into chiropractic. As good a job as chiropractic

colleges may do in educating chiropractors in core methods of the profession,

the fact is that they have never in the century plus that our profession has

existed originated a single chiropractic technique and their research of

chiropractic methodology has trailed the origination and implementation of

these techniques, even their introduction into core chiropractic curriculum by decades.

Therefore the OBCE has recognized that the life blood of the profession is

creativity in the field and has promulgated rules that see to public safety

while making sure not to suppress the one source that has historically produced

what we do as chiropractors – with the realization that we do a variety

of some favored by one contingent of the profession and some favored by the

other. Patients are benefited by being able to select in a relatively

free marketplace of chiropractic methodology.

So, what Joe thinks is good

effective chiropractic, what his patients tell him is what they understand and prefer,

has nothing to do with what the OBCE permits. Dr. Phil may like the

unsubstantiated idea that all chiropractic techniques should be supported by some

mysterious quota of peer reviewed research articles, all the while practicing

chiropractic techniques that were introduced to the profession without ever

meeting his arbitrary standard; but that too is irrelevant. By the way, the NMT

study published in the Journal of Complementary and Alternative Medicine on the

use of NMT to heal alveolar osteonecrosis – a condition to my knowledge

never reported in a peer reviewed journal to respond to anything but surgery,

has been posted here on the OregonDCs forum without much comment.

Another study has been completed on NMT in the treatment of childhood autism

has been completed and will be published soon and information on this is

available on the Autism One website.

That said, posted below is the

ETSDP rule. As you will see, it affords considerable latitude in the

practice of new methods not taught in chiropractic colleges. The rules

look at the inherent risk in the procedure. They require informed consent

in some instances. And, otherwise, these are rules that do not seek to unduly

restrict the introduction of new methodology to our profession.

Certainly, the rules do not hinge on the kind of discussion we have heard from

a few posters on this forum

S. Feinberg, D.C.

The majority of the ETSDP rule:

811-015-0070 Scope of Practice Regarding Examinations, Tests,

Substances, Devices and Procedures

(1) The Board may examine any diagnostic and/or

therapeutic examination, test, substance, device or procedure, herein after

referred to as ETSDP, to determine its

acceptability for patient care. The Board may require a Chiropractic physician

to provide information on any ETSDP for

determination of its status. The Board may take into account all relevant

factors and practices, including but not limited to, the practices generally

and currently followed and accepted by persons licensed to practice

chiropractic in the state, the teachings at chiropractic schools accredited by

the Council on Chiropractic Education or its successor at any time since 1974,

relevant technical reports published in recognized journals and the

desirability of reasonable experimentation in the furtherance of the

chiropractic arts.

(2) A Chiropractic physician may use any diagnostic

and/or therapeutic ETSDP which is

considered standard. A standard diagnostic and/or therapeutic ETSDP is one in which one or more of the following

criteria have been satisfied:

(a) Is taught or has been taught by a chiropractic school accredited by

the Council on Chiropractic

Education

or its successor at any time since 1974, or health professions' courses taught

by regionally accredited colleges with subject matter that is within the scope

of chiropractic practice

and has

not been disapproved by the Board; or

( Has been approved by the Board through the petition process:

(A)

The petition requires a formalized agreement of 10% or more of the Chiropractic

physicians,

holding an active chiropractic license in Oregon, attesting to the safety and

efficacy of a

particular ETSDP. The petition shall be

submitted in writing to the Board by any party

wishing to establish any ETSDP as

standard. It is the responsibility of the petitioner to gather

the required evidence and supporting statements. It is the sole responsibility

and discretion

of the Board to review the sufficiency of the evidence in the petition and to

make a

determination whether to concur and affirm the ETSDP

as standard or to deny the petition.

The Board may, but is not required to, hold a public hearing on any petition.

The Board shall

make its determination and reply to the petitioner within 180 days of receipt

of the petition

unless the Board and the petitioner mutually agree to extend the deadline;

(

The petition shall specifically address the following issues:

(i) The kind of ETSDP that is the subject of the petition,

i.e., whether it is an examination, a

test, a substance, a device, a procedure, or a combination thereof;

(ii) A detailed description of

the proposed ETSDP;

(iii) The clinical rationale for the

ETSDP;

(iv) A method for determination of

appropriate termination of care and/or consultation to

other providers with special skills/knowledge for the welfare of the

patient;

(v)

Whether the proposed ETSDP is to be

used by itself or used in addition to any other

generally accepted or standard ETSDP;

(vi) A description of known or

anticipated contraindications; risks, and benefits;

(vii) A description of any sub-populations

for which greater risk or benefit is expected;

(viii) A description of any standard ETSDP for the equivalent condition together

with its

relative risks and benefits; and

(ix) An assessment of the expected

consequences of withholding the proposed ETSDP.

©

Is supported by adequate evidence of clinical efficacy as determined by the

Board. In determining

adequacy the Board may consider whether the ETSDP:

(A)

Has clinical rationale;

(

Has valid outcome assessment measures;

©

Is supported in peer reviewed literature;

(D)

Is consistent with generally recognized contraindications to chiropractic

procedures; and

(E)

The potential benefit outweighs the potential risk to the patient.

(3) A Chiropractic physician may use any diagnostic and/or

therapeutic ETSDP that has not met the

criteria of subsections (2)(a) or ( or © of this rule as investigational. It must

show potential merit for effectiveness and be of acceptable risk. Documentation

requirements are based on potential risk to the patient. All investigational

diagnostic ETSDP's must include or be

accompanied by standard diagnostic procedures until full Board approval is

attained under the criteria cited in subsections (2)(a) or ( or © of this

rule. Nothing in this section is intended to interfere with the right of any

patient to refuse standard or investigational ETSDP's.

In determining risk, the Board may use the following criteria:

(a)

For minimal risk procedures, defined as those which when properly or improperly

performed on

the general population would have a slight chance of a slight injury and when

properly performed

on select populations have an extremely remote chance of serious injury:

(A) Informed consent is suggested but not required; and

( The Chiropractic physician is recommended but not required to

participate in or conduct a

formal investigation of the procedure.

( For low risk procedures, defined as those which when properly

performed on the general

population have a slight chance of mild injury, when improperly performed on

the general public

have a mild chance of mild to moderate injury, and when properly performed in

select

populations have a remote chance of serious injury:

(A) Informed consent is required; and

( The Chiropractic physician is recommended but not required to

participate in or

conduct a

formal investigation of the

procedure.

©

For moderate risk procedures, defined as those which when properly performed on

the general

public have a significant chance of mild injury and a mild chance of moderate

injury, when

improperly performed on the general population have a slight chance of severe

injury, and when

properly performed in select populations have a slight chance of serious

injury.

(A) Written informed consent is required; and

( The Chiropractic physician is recommended but not required to

participate in or

conduct a

formal investigation of the

procedure.

(d) For high risk procedures, those which when properly performed on the

general population have a

significant chance of moderate injury and a slight chance of serious injury,

when improperly

performed on the general population have a significant chance of serious

injury, and when

properly performed in select populations have a significant chance of serious

injury;

(A)

Written informed consent is required; and

( The Chiropractic physician is required to participate in or conduct a

formal investigation of

the procedure under the auspices of,

or in conjunction with, any other health care

professionals knowledgeable and

competent in the care and treatment of potential serious

injuries.

(e) Board approval is required of all moderate or high risk procedures.

From:

[mailto: ] On Behalf Of Sharron

Fuchs

Sent: Wednesday, April 21, 2010 12:54 PM

Subject: New Techniques

How are new

techniques brought in to our scope of practice? Must all techniques be taught

in a Chiropractic college, in approved post-graduate course or reviewed and

added by the board? Can I make up a technique and call it something like

‘ Sharron’s healing’ , teach it , practice it under my

license , collect money and be OK as a licensed healthcare practitioner?

s. fuchs dc

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