Dynamic Chiropractic - September 1, 1994, Volume 12, Issue 18|
Orthopractic under Scrutiny
Exclusive interview with Murray Katz, M.D., incorporator and sole director of Orthopractic Manipulation International, Inc.
With the emergence of the "orthopractic" movement, Dynamic Chiropractic has initiated a full investigation of the group. In the process, numerous contacts have been made and copious amounts of information have been gathered: corporate records, transcripts, and many internal documents. After examining that data, several critical questions come to mind:
Why was Orthopractic Manipulation International incorporated as a for-profit company with Dr. Katz as the incorporator, sole director and in complete control of all stock?
Before anyone can put any faith in a new organization, they need to know its mission, who's involved, and the credibility of its leadership. To answer these and other questions, we went straight to the person referred to as "the entrepreneur behind this (orthopractic) society," Murray Katz, MD.
The interview lasted an hour and forty minutes, which when transcribed, covered 28 single-spaced pages. The entire interview will be presented in three parts (arranged by subject matter) in the next three consecutive issues.
Interview with Murray Katz, MD
Part I"DC": When you requested this interview, you wanted to comment on the reasons that you started orthopractic. Please do so now.
Dr. Katz: The Orthopractic Society was started by a group of people, about three or four people within the pediatric community in Canada, as well as physiatrists, two physical therapists, and a chiropractor who, spontaneously after many years of communicating with each other, came up with a solution which they thought would be suitable to everybody. It was a reflection of the great concern within the pediatric community to try to find some way of resolving what we consider to be dangerous in terms of chiropractic involvement with children. It was a concern with the chiropractor involved to try to provide a way for chiropractors who wanted to limit themselves to scientific use of manipulation therapy to have a way of doing that. It was a way for the medical people involved, other people involved within the medical establishment, to say that we can accept chiropractors who function in this way. So the society arose spontaneously through a discussion group which eventually grew to 23 people, and eventually formulated the name orthopractic, and the written guidelines.
There are many chiropractors involved in that formulation: physical therapists were involved, osteopaths, orthopedic specialists, and it took almost two years of consultation and sharing of opinions. The National Association of Chiropractic Medicine was not involved at the beginning and did not get involved until the process was about three-quarters of the way through. It is also the policy of the group not to have any official association with any established group such as the American Medical Association, or the Canadian Medical Association, or the American Chiropractic Association, or the Canadian Chiropractic Association. Our concern was simply scientific: to study the available information and to work out a way where everyone -- chiropractors, physical therapists, pediatricians, doctors -- could work together. Part of the process involved people who were in government and were concerned about what government was paying chiropractors for; part involved insurance companies who were concerned about the same thing. Everyone eventually came together as a group, which grew to be close to 30 people, and finally the document was produced, and the association was formed.
My function is as a member of the editorial board of the pediatric section. I have been very prominent because pediatrics has been a big concern of the group, and because the attack of the chiropractors has been against me on a personal basis. But in fact, there are I think, much more significant people other than myself involved behind the scenes doing a great deal of work. I hope my own personal involvement will not be too much longer, and in the future curtailed, because I have many other interests.
"DC": How many members does the Orthopractic Manipulation Society have?
Dr. Katz: In terms of registered members now, we're close to 1,000. I would say we're about seven or eight hundred at this point in time, but we have the potential for many, many more members. We have been officially endorsed by the McKenzie Institute International, which has over 20,000 members. We're endorsed by the Back Institute, which has many members. But we're not concerned about the numbers that much, we're concerned about what the scientific evidence is. We don't really care how big we are. We estimate that we will grow to two or three thousand members within probably a year or two. Our concern really is to give a way for those chiropractors who wish to practice safe, scientific manipulation, a way to do so, and get positive recognition from the medical establishment. I think that I personally have done more for those types of chiropractors getting acceptance within the medical profession, as I am very much involved in the medical establishment, being a teacher and being very involved in lots of works, some committees and stuff like that within the medical establishment. By medical establishment I mean sort of an upper scientific medical community.
I think I've done more for chiropractors who want to practice in a safe and scientific way and be recognized than probably any other doctor, because I've gone to my colleagues in the medical licensing boards and in the associations and different groups and said: "If there are chiropractors who want to reach out to us, we have to reach back to them, and we cannot just call everybody 'quacks' and be negative. We have to be positive, we have to sympathize with those who want to change, we have to give them a way to be identified, to get out if they want to, and that way is to use the suffix orthopractic after their name." I am constantly convincing my medical colleagues -- pediatricians, orthopedic specialists, people in licensing boards, people who have influence within the medical community -- to reach out to chiropractors and to welcome them into the scientific community.
"DC": Why are you working with the National Association of Chiropractic Medicine?
Dr. Katz: The National Association of Chiropractic Medicine applied as individual members to join the Orthopractic Manipulation Society International. As OMSI expanded and was looking for people for its editorial board, some of the members of the NACM have joined. But not all the chiropractors who are on our boards working with us are only NACM members. It really depends on scientific background, qualifications, training, a whole bunch of things like that. We have a lot of sympathy with the chiropractors we've met from the NACM because we find that they seem to be the easiest group to accept what we consider to be the truth about what manipulation can and cannot be used for.
"DC": Are you aware that the executive director of the NACM, Dr. Ron Slaughter, is known to have worked with organizations that have tried to destroy the chiropractic profession?
Dr. Katz: I don't believe that. I don't think that Ron or myself, or anybody else, is out to destroy the chiropractic profession. I believe that there are two professions out there: There is a profession which believes that manipulation of the spine can be used to treat things other than musculoskeletal complaints, and there's a profession out there which doesn't believe that. Just as I have a right to limit myself to pediatrics -- and by doing so I don't destroy the medical profession -- I don't see why chiropractors should object to someone wishing to limit themselves to musculoskeletal care only.
I think the concern of Ron, the concern of the medical community, and the concern of medical science, and of many, many people in government and insurance companies and so on, is to see that medicine, including manipulation therapy, is practiced in a limited, safe, scientific way. I think chiropractors who practice it to treat all types of things will always exist. We have the finest hospitals to treat cancer, but people still want to take megavitamins to treat cancer. We're not going to get rid of that. I think if people want to see a chiropractor and they feel that it is helping somebody for whatever is bothering them, I can't stop that and I don't care to stop that. What I object to is the fact that the schools which graduate chiropractors who believe in chiropractic philosophy, these graduates are allowed to call themselves doctors, they're allowed to use x-rays, they're allowed to prescribe their own brand of medication, they're allowed to be publicly funded. If a chiropractor wants to claim to cure a kid's earache by manipulation, that's his right and I don't really think I'm going to stop that. But if I am going to pay for it out of my tax dollars, then I think there is an issue there. If someone would graduate from an orthopractic school, I think they should have those rights, not from a chiropractic school.
"DC": Were you aware that Dr. Slaughter in his own curriculum vitae, page 2, states that he acted as a consultant for "Mr. Doug Carlson, JD, counsel for the American Medical Association, regarding the 'Wilk' trial"; "Mr. James Cerney, JD, counsel for the American Radiology Society, regarding the 'Wilk' trial"; "Dr. William Jarvis, PhD, president of the National Counsel Against Health Fraud, and Dr. John Renner, MD, chief medical advisor to the president of the Senate Investigative Committee on Health Fraud"?
Dr. Katz: Sure, I know that Dr. Slaughter was asked by those people, and I think the issue really is, these types of personal attacks or innuendo about what people do ... really there's only one issue here: Do subluxations exist in any way to affect our health? Chiropractic is based on three theories, really: that joint dysfunctions exist from birth on in just about everybody; that these affect our total health; and that these can be adjusted and fixed. This is a theory which will never be shown to be true because the body just does not work that way. You cannot redirect nerves, you cannot redirect the way the body is built. You will never produce a study showing that otitis media is caused by a pinched nerve because the glossopharyngeal nerve doesn't go there. So we can talk about, as people have talked about, me and what New Zealand said, or about what Ron did. The trouble with chiropractic and the reason it really hasn't changed in a 100 years is because its acceptance is not going to be based on challenges to the AMA, winning Wilk trial legal cases, suing people, having massive publicity campaigns launched in reaction to "20/20," or the Wall Street Journal or Consumer Reports. And there's more coming up. It's going to be changed by chiropractors accepting that musculoskeletal care has a limited and a valuable role to play. And all of the acceptance which appears to be out there, in terms of chiropractors and doctors working together, is based on doctors believing that those chiropractors treat only musculoskeletal care.
Now that the medical doctors and the community have a way of distinguishing those chiropractors who treat only musculoskeletal conditions, and don't claim to treat colic or bedwetting, I believe we are going to see a massive shift away from general chiropractors who claim to treat everything in terms of medical referrals, medical cooperations -- medical cooperation with them -- to those chiropractors who identify themselves as orthopractic. We see that going on now with hundreds of requests that we've received from doctors and radiologists and people in the medical community saying, "Can you give me the name of someone who's orthopractic?"
Chiropractic has gotten stuck in treating five or six percent of the population. Becoming orthopractic affords chiropractors the opportunity to move into the mainstream of medical science, expand the number of people they'll be treating, work cooperatively and scientifically with a group of doctors. And I am proud and happy to help any chiropractor who wants to do that -- to reach out to them.
"DC": Much of your internal communication suggests that you have testified before President Clinton's health care reform panel against the inclusion of chiropractors as primary contact providers. Is this accurate and would you comment?
Dr. Katz: There are some things I am doing which I consider still confidential. I will tell you that the chiropractic profession, the American Chiropractic Association, has spent a lot of money trying to get coverage under the U.S. administration. I believe that whatever acceptance they do get will be under orthopractic limits and not general chiropractic. That is the impression that I have. I can't comment specifically on the people who have contacted me and the people I'm meeting with, but I can say that in the long run I really am 95 percent convinced that chiropractic inclusion will be under orthopractic limits. Whether that will be right at the beginning, because there is a battle between the politicians and the civil servants, whether that will be a year down the road or two years down the road, I can't see it coming out any other way. There are just too many people within government, within the insurance industry, within HMOs and so on, who are saying very clearly, "What are the orthopractic guidelines, how can we work only with chiropractors or physical therapists who conform to those guidelines?"
"DC": What was your role in the recent Consumer Reports article on chiropractic?
Dr. Katz: I asked Consumer Reports if I could share some information with them. They agreed that I could share some information with them. I shared that information with them. I found them very critical, very questioning, very concerned. About a month or two months before the article came out, I even wrote them a letter saying I think that it's going to be a good article from the way it seems to be heading. That was basically it. I had no role in writing it in any way whatsoever. I was not quoted in it in any way whatsoever, and there were many other people who contributed. I think they spoke with several hundred people, including many more chiropractors than I did. But I expressed myself as to what I thought was important and what was not, and I think that the result where they only recommended the Orthopractic Manipulation Society International is very simple to understand. The Consumer Reports showed very clearly that chiropractic philosophical teaching is not true, there are no studies, and there never will be studies because that's just not the way the body works. Consumer Reports was looking for a group which would say, "We only do manipulation therapy for its safe, scientific treatment of low back pain." Our group was the only one, I think, that was willing to say so. I was pleased that we were recommended, and it was a bit of a surprise in the end that it turned out as well as it did because I found them very questioning and very critical along the way.
"DC": Betty Jane Anderson, special counsel for the Health Law division for the American Medical Association, has stated that you claimed in April that you were "working with Consumer Reports on an article that was published in the June 1994 issue on chiropractic," and that you further stated that "the concept of orthopractic is to separate manipulation, a therapeutic modality, from the debate and attack chiropractic philosophy." This is also supported by different comments made verbally. Is attorney Anderson correct in her depiction of your activities?
Dr. Katz: I wrote her one letter, I guess it was maybe seven or eight months ago, I don't know the exact date and I don't have it in front of me, and if that's what I wrote in the letter then I wrote that. My working with Consumer Reports was trying to convince them to see what I would do. Subsequent to that, I never received any response, and I have never written to them again, because I don't think this is an issue that has anything to do with American or Canadian or any other medical associations. This has got to do only with what is scientifically true and what is not true.
"DC": In some of the initial communication, Dr. Slaughter claimed in print and in his interview with Dynamic Chiropractic, that "the AMA is in discussion with Dr. Katz at this time for the adoption of orthopractic. Is this true and who in the AMA are you working with?
Dr. Katz: No, absolutely not true. What was confusing that there were doctors who were members of the American Medical Association who were asking for information from us. Dr. Slaughter asked me at one point, "Are these doctors members of the American Medical Association?" I said, "Some of them are and some aren't." But there is absolutely no relationship whatsoever between the OMSI and the AMA, and it is forbidden in our frame of reference. If you look at the guidelines and how they are formed, it is specifically forbidden for us to have any type of organization. We're not interested. We don't take a vote to decide whether pinched nerves cause otitis media. So there is absolutely no involvement of the organized medicine in any way in this whatsoever, and this has got nothing to do with trying to get rid of chiropractic. It's got to do with making safe, scientific manipulation therapy available; its got to do with warning the public about chiropractors who claim to use manipulation to treat many diseases, and who take x-rays and are anti-immunization.
Just as I have personally warned the public in articles I've written about the dangers of thalidomide, when we go back 25 years, I've warned the public about high cost of medications; I've written articles against the medical profession for some of the price tactics that go on, which I think are not proper or some of the conflicts of interests with doctors owning lab companies where they've asked people to go get blood tests at. This is a very positive thing, it's not a conspiracy. It's a simple scientific issue. People have said to me, "You're trying to get rid of chiropractors and make sure that chiropractors only see patients on referral." This is not true, I am 100 percent in agreement with chiropractors who are orthopractic being portal of entry. I don't think that people have to see a doctor first. I don't think chiropractors are primary care physicians because to be a primary care physician means that you must have a treatment for everything, and if you believe that manipulation is a treatment for everything, then you're not following scientific norms. But I think that a lot of chiropractors know a lot more about the musculoskeletal system than many, many doctors do, and I have absolutely no hesitation in seeing a patient who has musculoskeletal pain, and referring them to a chiropractor who sticks to the orthopractic guidelines. Personally, I would have no hesitation in having myself so treated by such a chiropractor.
"DC": Would you consider the letter that Dr. Slaughter sent out to many new members several months ago, in which he stated that the AMA was in discussion with you for the adoption of orthopractic, misleading?
Dr. Katz: Yes. Nobody does everything perfect all along, there's been lots of misleading enthusiasms expressed. I think that my even writing a letter to the AMA at one point was an error. I was concerned about possible legal ramifications because I know chiropractors in the past have been very quick to sue and to attack, and I was probing for some information, and then I realized that first, it wasn't necessary, and second, the Orthopractic Society subsequently said that we should not even contact any official associations. But I can tell you that there are many, many what I consider to be very influential and very important physicians in the United States, in Canada, and now in Europe and other countries who are very, very supportive of the orthopractic idea. Some of these people do have a lot of influence within those organizations, but it's all on an individual basis.
"DC": You state in your patient guidelines that orthopractors and by reference chiropractors are, "self-limited specialists." You state in those same guidelines that any and all treatments by a specialist should be with the full knowledge and consent of your family physician. How does this work with your last statement, that suggested that chiropractors need not receive patients by referral?
Dr. Katz: I think that just as someone could go see a dentist directly, I think someone could go see a chiropractor directly. So whatever inconsistency appears to be there, it's not there in my way of thinking. I have absolutely no objection to someone who has a backache going to see a chiropractor directly. I think in 99 percent of instances, they've already seen their doctor anyway, and even if they're seeing the chiropractor there's nothing wrong with the chiropractor referring them back to the doctor if the chiropractor feels that it's necessary.
"DC": But your patient guidelines here have many statements such as: "As this is a limited scope of practice, it is recommended that you have a family doctor acting as a general health consultant who is aware of this treatment."
Dr. Katz: That is not in the orthopractic guidelines.
"DC": This is the Patient Guidelines for Spinal Manipulative Practice put out by the Orthopractic Society.
Dr. Katz: I didn't write that. The official guidelines of the Society specifically ... there's no mention of referral. Specific guidelines of the Society say that a person can go directly to a chiropractor.
"DC": Do the Orthopractic Manipulation Society International and Orthopractic Manipulation Society USA have the same guidelines?
Dr. Katz: Yes. The green pamphlet is the only official guideline. People can give little different interpretations to it if they like, but the official guidelines which are reviewed every two years are the green pamphlet, and that's the only official guidelines.
"DC": You may want to talk to Dr. Slaughter then, there's another set out, and I'm quoting from those right now.
Dr. Katz: I can just say that the only official guidelines are the green ones. Things have happened so fast and so dynamically that we have had trouble keeping up and responding to all the information. I think that after the national convention which will take place at the end of September, we hope people will communicate with each other more clearly. I've never met Ron Slaughter, we've never really met, we've never had the opportunity to sit down and talk. There's a lot of things that are not as perfect as they should be, but we're all extremely impressed with the rapidity with which this idea has been accepted, and extremely pleased by the large number of chiropractors. When you look over the CVs of these chiropractors we've (been) very impressed. We have some who are PhDs, and some who are MDs as well as chiropractors and we're just very, very impressed with the quality of people we have coming to us. I will do everything I can to make any chiropractor who wishes to limit their care to musculoskeletal conditions, welcome within the medical/scientific community, which is where the lion's share of care lies, and not in the six percent which wants to treat everything under the sun by manipulation therapy.
"DC": When you spoke before the Ontario Medical Association in Toronto regarding orthopractic you stated, "It does not assess competence. We don't care who joins. It is not a medical issue, it is a political perception, a public issue. So one of the weaknesses of the Orthopractic Society is that it does not assess competence. We have no idea whether the people joining are good or bad manipulators, and quite frankly we don't care." Isn't this in conflict with getting Consumer Reports to endorse orthopractic, and to suggest that the general public look to you for referrals when you're referring to somebody (when) you have no clue as to how competent they are?
Dr. Katz: Sure. We have no way of knowing how competent they are, but we do know that they have a chiropractic degree, and we assume that that makes them qualified. But that issue will be addressed in September. There is a competence committee, but not everything can be done right at the beginning. We have not received a single complaint from any member of the public who has received our correspondence, and that's in the hundreds, the requests that have come in. We did nothing, again going back to Consumer Reports. We didn't know what Consumer Reports was going say at all. I was very pleased when I received it, and I was happy. I was as nervous as anybody else about what they would say in the end, especially after reading the previous article on homeopathy and the other articles, I was concerned. But in the end it turned out. I think there should be a message in what they did for chiropractors. Why did that happen? Why wasn't the American Chiropractic Association recommended as a referral source? Why wasn't the Canadian Chiropractic Association? There's a message there, and chiropractors should look at that instead of attacking everybody and saying, "Well, why did that happen?" and "Why will that continue to happen?" It will happen because the public now has a way of distinguishing manipulation therapy as a treatment from a philosophy of its use, and it also has a way of distinguishing the issue of infants and children. You don't appreciate the impact upon the medical community when the chiropractors started this aggressive tactic five or six years ago of promoting chiropractic pediatrics. It caused a reaction within the pediatric medical community which I think has really done the entire chiropractic profession a tremendous disservice, a tremendous disservice for all of their political goals. And it sparked the initiation of the Orthopractic Society.
Editor's note: In Part II, Dr. Katz will answer questions
regarding: the differences between physical therapist members and
chiropractic members; why Orthopractic Manipulation International
was incorporated as a for-profit corporation; the orthopractic
involvement in Consumer Reports, "20/20," the Wall Street Journal,
et al, and what is the involvement of physical therapists is in the
orthopractic organization (which apparently is greater than the