FSUblius

No "Need" for Chiropractic School

There are a couple of articles in newspaper this morning about the questionable claims of "need" surrounding FSU's establishment of a stand-alone chiropractic college.  An article in the St. Petersburg Times notes:

On that front, the numbers are not in the school's favor.

Florida has more chiropractors per capita than the national average and needs 108 a year to keep up with demand, according to a recent staff report to the Board of Governors, which oversees Florida universities.

Meanwhile, a new, private chiropractic college near Daytona Beach is expected to produce 188 graduates per year by 2007.

Given the potential glut of chiropractors, a $60-million chiropractic school at FSU will be a tough sell, said Board of Governors Chairwoman Carolyn Roberts.

An article in this morning's Tallahassee Democrat expresses similar doubts about FSU's claims:

in its analysis of FSU's report, the Board of Governors staff called the school's premise "overly optimistic." The staff said Palmer College of Chiropractic Florida, a new school in Port Orange, expects to eventually graduate 188 students each year - more than enough to meet the state's demand.

Meanwhile, the Democrat reports, the lobbying arm of the Florida Chiropractic Association is pointing to active chiropractic licenses, which are down from 4,687 to 3,873 in 2004, as a basis for "need."  This measure is specious, given the presence of a new private college which is now training chiropractors in Florida. 

Further, without knowing the details about chiropractic licensing in Florida, one obvious question must be asked before making a policy decision based on licensing numbers.  This is a drop in active licenses of more than 15%.  That seems signficant and very odd.  If, as the FCA claims, it is due to demographics (i.e., retirements), we ought to see that same demographic trend in other states for 2004.  On the other hand, what percentage of the drop be due to official retirement of a license, as opposed to late annual licensing dues?  In many professions, it is not uncommon for licensing boards to provide a grace period for the payment of dues.  More frequently than you might expect, licensed professionals are behind in the payment of such things, or they may fail to comply with requirements such as submission of insurance of continuing education information.  Within a year, the regulator can catch up with payments and other reporting information, but sometimes this takes time, since people move, etc.  Again, we are being thrown numbers without any careful analysis.  Hopefully, the BOG will carefully assess the numbers rather than take them at face value.  Without knowing more, I am not sure they really mean anything at all.

Although it is unlikely, even if numbers do determine some need for chiropractors, or some need for more minority chiropractors (no one can argue with this!), there is the independent question of whether a research university such as FSU needs to step down this murky path.  The University of Central Florida seems much better situated for such a college, if it is appropriate at all.  Alternatively, if the state wishes to expend public resources to train minority chiropractors, it can give a tuition scholarship to minority students for a fraction of the cost of FSU's proposed program.

BOG Report on Chiropractic

Over at the always lively Warchant.com, a poster summarizes the now-available BOG Report on FSU's chiropractic proposal"

The BOG hired two outside chiropractor/scholars to look at FSU's proposal, and they basically found the curriculum was sound, by chiropractic standards, and would advance the chiropractic profession. However, the report also states: 1) the need for chiropractors in Florida is not clear (since Florida has more chiropractors on average than most other states); 2) FSU's budget forecast for the program is contingent on enrollments, but FSU's 5-year curriculum commitment may deter most students from enrolling in the first place; 3) FSU does not need a chiropractic program to engage in chiropractic and alternative health research; 4) no previous SUS plan included chiropractic, and it is unclear how, if at all, such a program is consistent with FSU's mission as a research university; 5) if the SUS were to adopt a chiropractic program, many other SUS universities would be equally, if not better, equipped than FSU to house such a program, given their programs in physical therapy, etc.

More on this new development later!

The Specious "New" Science

The specious arguments about chiropractic science continue to be spread on the Internet as a basis for supporting FSU's chiropractic proposal.  In response to a Tallahassee Democrat article on the questionable science behind chiropractic, on which I blogged earlier today, in an editor's comment in ChiroZine, published daily by the Chiropractic Resource Organization it is now claimed:

Understanding the 'science' in chiropractic has been confusing for both chiropractic and medicine. What doesn't seem to be understood is the possibility that we could be dealing with a relatively 'new' science; that of a neurocognitive discipline attempting to correlate mind - body function. While 'neurocognitive' is an apt discriptor for the inquiry, more exists that has not been understood possibly because of the reductionist nature of the inquiries. That chiropractic has been delving into a neurocognitive relationship in brain - body function, it is more likely to be deeper; that a 'neuro - endo - cognitive' relationship exists in communication pathways of the body; that nerves and endocrine relationships exist that require a different approach to study. Either way, that chiropractic is a player in all this will not prevent the chiropractor from searching for answers. It is the science community that must acknowledge the chiropractic profession as an innovator in a new kind of science. However, it is time to add definition to the new science so inquiry can begin with academic guidance.

If this "new" science solves the mind-body problem, we should hope to see many more Nobel Prizes coming out of FSU.  However, I must ask what, if anything this adds to scientific inquiry.  Neuroscience and cognitive psychology have been exploring these questions for decades.  How, exactly, is the mechanism they are exploring "reductionist"?  As a matter of argument for scientific inquiry, this plea rings familiar -- like those who posit the existence of a planet or being from which all humans came from because we do not know exactly how we evolved and we know we are here and that life has many great mysteries.  That's the "new" science in evolution.  It's called intelligent design.

Countdown

With the Florida Board of Governors poised to issue a key vote this week, newspapers in the state are reporting on FSU's chiropractic proposal -- a "proposal" that the FSU trustees affirmatively decided not to take a position on and that every member of FSU's faculty who has spoken does not want to see continue.   Meanwhile, the Florida Chiropractic Association has stepped up its own media effort -- as it describes it, it is "pumping out information" to the media (including information about a completely unrelated antitrust case -- this is not about whether chiropractors may compete with physicians in consumer markets), encouraging its members to send letters to the editor of major Florida newspapers, and launching an online petition.

This morning's Tallahassee Democrat has an article that discusses the issue before the Board of Governor's this week.  As the Democrat describes it:

They get their wish Thursday, but not exactly as they hoped. FSU trustees have taken no position on the program initiated by lawmakers. They are asking the Board of Governors for more time to examine their own proposal.

"I believe our board is prepared to make a decision," Carolyn Roberts, chairwoman of the state board, said Friday. "It would not surprise me if it were an up or down vote."

It's unlikely the state board would support the program because it hasn't been fully vetted by the university. But it could vote to reject it or send it back to FSU for more work. The governors are faced with asserting their authority over a graduate program that the Legislature already has authorized.

Another article in this morning's Democrat questions the scientific basis of chiropractic.   In that article, FSU Provost Larry Abele concedes that "its a good question" whether such a questionable area of scientific inquiry has any place on FSU's campus.  A few other key facts are mention in the article, including:

1)  That, over the past 10 years, the federal government hasd only spent about $25 million on chiropractic research.  This is a much smaller amount than the numbers FSU's claims in its proposal.

2) According to the newspaper, FSU Provost Larry Abele says that "about 90 percent of chiropractic research is in clinical trials, which measure patient response, and about 5-10 percent is in the basic sciences."  He also is quoted:  "And the basic sciences is very, very preliminary."  Clinical trials  for pain treatment -- which often measure patient satisfaction -- are fairly low on the scientific ladder unless they adhere to statistical criteria (including independent verification), which many of the clinical trials Abele refers to do not.  As he also mentions, the basic sciences are the more difficuly standard for chiropractic, and to date there is very little (if any) basic evidence regarding the scientific mechanisms which would sustain the claim of necessity for independent chiropractic treatment -- as opposed to treatment by medical physicians, physical therapists, or others.   

 3)  Several FSU faculty have serious doubts about the scientific claims.  Quoted in the story are Ross Elington, a professor of biological science at FSU, Marc Freeman, an FSU professor of biology, and David Houle, also a professor of biology at FSU.  They join the many other FSU faculty who question the scientific and research basis of FSU pursuing such a program.

A Palm Beach Post editorial this morning has some blunt words of criticism for FSU and its trustees, as well as some advice for the BOG:

the only established basis for the FSU program's existence is as a favor to powerful state lawmakers and lobbyists with FSU connections. Those include Sen. Jim King, R-Jacksonville, who as last year's Senate president railroaded the program and its financing to his alma mater; Sen. Dennis Jones, R-Seminole, then the majority leader and himself an alumnus and chiropractor who reportedly hopes to work at the school; and FSU booster and fellow alum Guy Spearman, lobbyist for the Florida Chiropractors' Association. FSU is run by another former House speaker and alumnus, President T.K. Wetherell.

When FSU's Board of Trustees voted 11-2 last week to forward the chiropractic proposal to the Board of Governors, rather than legitimize the program that is vipering its way backward through the system, Gov. Bush slammed the trustees for dodging the issue. "They should have voted their conscience," he said. "This has gotten way out of hand." The same trustees who had advertised to hire a dean for the chiropractic school wisely concluded that this contrived political showdown is not their fight.

It is clear that FSU's trustees have evaded their statutory mandate; they have refused to take a position.  If the BOG wishes to refocus issues at FSU and within the state system, it must vote no on FSU's program.   Sending it back to FSU will only delay the inevitable -- that the program will not go forward -- while distracting FSU and its faculty from their key mission.  In fact, the Governor's budget this year makes the budget appropriation contingent on a vote of approval by the BOG.  Without a yes vote by the BOG, there is no point on continuing to waste time on this issue.

The Murky Path of Sublaxation

FSU Provost Larry Abele, with the help of several chiropractors who have been hired by FSU, has made a commendable (but I think failed) effort to focus FSU's proposed chiropractic program on science.  One of Provost Abele's claims, from both FSU's proposal and newspapers accounts, condemns some of the scientific claims of the chiropractic community, and attempts to assure FSU's faculty, the Board of Governors, and members of the public that FSU will not go down this path.  For example, according to the proposal that Provost Abele purports to have prepared: 

Our first commitment is to a rigorous scientific educational program, one that would explicitly reject some current chiropractic activities, such as many of the articles published in the Journal of Vertebral Subluxation Research.

As Provost Abele has elaborated, that Journal includes such "peer-reviewed science" as the benefits of spinal manipulation to promote fertility in infertile women, or to reverse multiple sclerosis and Parkinson's disease."

The Editor of the Journal of Vertebral Sublaxation Research, from the esteemed Life University (in Marietta, Georgia) responds to Provost Abele:

His indignation that chiropractors would have the nerve to study such things as chiropractic's effects on infertility and Parkinson's reveals the underlying issue that any research to come out of a chiropractic program at FSU will no doubt remain locked securely in the box of neck pain, back pain and headaches where organized medicine would like to keep us.

It is interesting that Abele chose to single out JVSR in regards to chiropractic peer reviewed research and that he conveniently did not mention the Journal of Manipulative and Physiological Therapeutics (JMPT) which is also a chiropractic       research journal. A cursory search of that journal's contents revealed numerous articles on the treatment of non‑musculoskeletal disorders through chiropractic including one article on -- of all things ‑‑ Parkinson's disease!

Could it be that Abele did not mention JMPT because a chiropractor named Alan Adams who is FSU's faculty administrator for chiropractic initiatives is associated with many of the members of the Editorial Board of JMPT and also has a paper published in it?             

As for the unfounded accusations being hurled around by some of FSU's medical faculty that chiropractic is dangerous, I need only point to the relative malpractice costs for the two professions as evidence for which profession poses more of a public health threat.

In fact, this journal appears to be one of the most insecure scientific publications I have ever read.  Talk about unfounded accusations!!!! -- How, exactly, is it moving this debate (or for that matter sound policy, let alone science) forward to make a comparison of the risks and benefits of various treatments based on malpractice costs?   What a blatantly ridiculous claim.  Here is a recent editorial from the Journal, for those who are not famliar with its approach to science -- apparently, email politics are its primary form of scientific persuasion.  Whatever we think of the merits of the respective scientific claims of this political invective, it appears clear that, if FSU does establish as chiropractic program, there will be enourmous pressure from the profession to expand its curriculum to include some of the more suspect chiropractic treatments.

I think that all of this illustrates what a morass FSU is entering into if it continues to play around with a chiropractic program.  This is just not a game for serious science -- no one who is interested in objective science and sound policy should make qualitative claims regarding health care based on malpractice claims.  How, if at all, is this consistent with the mission and aspirations of a research university such as FSU????  Perhaps Florida's Board of Governors will tell us, as FSU and FSU's BOT has failed to.

What is a "Fair" Vote?

A story in the Tampba Tribune reports on how the Board of Governors expects a "fair" vote on FSU's chiropractic proposal next week.  It will not be a referendum on chiropractic, but "will be decided on whether the school fits FSU's mission as a top-tier research university and how well the school matches the state's priorities for public universities."  This would be a great addition to the debate -- with the exception of trustee Garcia, who voted and spoke against the proposal, FSU's trustees did not discuss how the school advances FSU's mission as a top-tier research university.  And, to date, on campus consideration of the proposal has not really occurred on what most faculty would describe as fair terms.  Hopefully, any decision the BOG makes will be based on facts.

From the fringes of the public sphere, discourse.net, by Professor Michael Froomkin at Miami, blogs on the chiropractic  college proposal at FSU:  "It’s not a science; in fact it’s more like a cult or a religion," says Froomkin. 

Downsizing Chiropractic and FSU's Academic Reputation

The latest national press on the FSU chiropractic proposal is a piece on today's Chronicle of Higher Education website (subscription required).  I suspect some version of this will appear in their print edition, widely circulated in national higher education circles, next week. 

Gov. Jeb Bush, a Republican, jumped into the debate on Tuesday, criticizing Florida State's handling of the matter and suggesting that the Legislature slash the $9-million appropriation for the chiropractic college to $1.9-million. He said that faculty members had been cut out of the debate, and that the university's trustees should have taken a stand on the college rather than turning to the Board of Governors. . . . .

The professors have been joined in their protests by prominent critics of chiropractic medicine from outside of Florida -- doctors who, Senator Jones said, have a bone to pick with the profession.

"I have no problem with these people quitting," said Senator Jones, a Republican, referring to the eight part-time Florida State professors. "If they're spreading professional bigotry, they shouldn't be teaching students anyway."

I thought that the main out-of-staters testifying last week were chiropractors themselves who support the proposal.  Does Senator Jones know who among FSU's faculty has signed petitions in opposition to the school?  It would seem that FSU is going to have to purge some of its faculty from far beyond the medical school before Senator Jones is satisfied. 

This morning's Independent Alligator, published by students at the University of Florida, contains an editorial against the chiropractic program:

This time, we don’t have to joke on FSU. They’re doing a pretty good job of it themselves.

In case you haven’t heard through the incredulous-student grapevine, FSU soon may add a chiropractic school to its “esteemed” campus.

But this is no laughing matter. The chiropractic-school proposal could have dire consequences for not only FSU’s integrity, but the integrity of the state university system as a whole.

The program would be the only one of its kind in the country, and not without reason.

I would suspect that, if the Board of Trustees or Board of Governors were to poll graduate students at FSU, they would hear similar such concerns.

Meanwhile, FSU's President and Provost continue to dig in their heels on the program, even though the budget has been substantially reduced, according to this Tallahassee Democrat story.  At least TK Wetherell, FSU's President, recognizes in that story that FSU has many bigger issues to confront.  Given this, however, it make no sense for him and FSU to waste any more of their political capital on the chiropractic program.

Florida Governor Bush Slams FSU Trustees/Cuts (Potential) Chiropractic Budget

According to this story in this morning St. Petersburg Times:

Gov. Jeb Bush on Tuesday criticized the way Florida State University has handled a controversial proposal to create the nation's first public chiropractic school, and called for deep spending cuts in the program.

Bush urged his appointees on the 16-member Board of Governors, which oversees Florida universities and must approve the chiropractic school, to "vote their consciences" in a critical meeting next week.

"They shouldn't be swayed by political pressure," Bush said. "This has gotten way out of hand. They ought to vote what they believe to be the right way to go for the state university system."

Bush's comments appeared to provide maneuvering room for members of the Board of Governors, most of whom are appointed by Bush, to vote against the school Jan. 27.

The governor also said he was disappointed in the way FSU has handled the project.

"I had hoped that FSU would have gone through the normal process for a graduate program of this magnitude," Bush said.

He said the proposal should have been thoroughly vetted by the FSU administration and voted on by the university's trustees. But that didn't happen.

Instead, the faculty was cut out of the process and the trustees punted the issue to the Board of Governors, voting last week to ask the board if the university can continue studying the proposal.

If the Board of Governors approves the school, Bush recommended spending $1.9-million on it next year, far less than the $9-million the Legislature passed last year. Bush said budget aides reached the lower figure after talking with FSU administrators.

The Board of Governors should do what is right and kill this program.  Not one faculty member on FSU's campus has indicated that they affirmatively want it.

Another story on the topic appears in the Palm Beach Post.

In the aftermath of the chiropractic program, perhaps Governor Bush will consider appointing an academic or two to the FSU Board of Trustees when the opportunity arises.  FSU graduates are in leadership positions at academic institutions around the U.S., including the current Chancellor of Washington University-St. Louis.  Other graduates are leading scholars in their fields across the world.  To bring credibility and vision to FSU's Trustees, it will be important to bring in trustees who are not lobbyists and politicians, and who understand a little something about what research universities do and how they operate.  We can not continue to squander signficant opportunities to advance the university as state and local politics steer FSU adrift from its core mission of academic excellence.

What? A Board of Trustees Is Supposed to Make Decisions?

National coverage of FSU's chiropractic flap continues -- most recently with a story this morning on the Inside Higher Education website.  As that story states:

As has become the norm in Florida in recent years, this flap includes long-running tensions between lawmakers and college leaders, charges of patronage, and concerns over the faculty role (or lack of it) in decision making.

The story also refers to this blog for a more informal take on the flap.

This morning, an editorial in the Tallahassee Democrat, which is known to reprint in whole press releases from FSU (typos included), praises the FSU Board of Trustees for showing respect for faculty in its decision last week.  Actually, it is news that faculty at FSU are jumping in joy that their trustees have now brought their politics onto campus.  What a delightful addition to the intellectual climate on campus. 

Perhaps a little distance from the state capitol clears the mind.  The St. Petersburg Times also has an editorial this morning, in which it correctly observes:

But the beleaguered Florida State University Board of Trustees can't hold meddling lawmakers entirely responsible for this mess. The board and FSU president T.K. Wetherell brought some of this on themselves.

Among the more specious arguments the board offered Friday as it ducked a decision on the chiropractic school was that the state Board of Governors and the Legislature had tied the university into a knot. Indeed, the Legislature, following the lead of then-Senate Majority Leader and chiropractor Dennis Jones, did appropriate $9-million last year to create the school. Indeed, the Board of Governors, created to insulate universities from political interference, did then tell FSU that legislative approval would not suffice.

But no one ordered FSU to ignore its own faculty, disregard the implications with national accrediting bodies and proceed to hire a chiropractic school dean without first asking either the state governing board or the people who have invested their educational careers there. For Wetherell to chide faculty opponents for failing to be "open-minded" took some cheek.

The Board of Trustees has failed at its task of making judgments about programs and priorities at FSU.  The result is to potentially pass the buck to faculty.  But why would it be desirable for a university President to bring its faculty into such a divisive mess at this late hour?  Shouldn't the President and trustees who supported this have vetted it with faculty earlier, rather than attempt to pass it to faculty or the Board of Governors now?  The Board of Governors can reject the proposal based on the merits, but it also needs to do the job that FSU's Board of Trustees failed to -- exercise some judgment and reject the proposal in order to insulate FSU's faculty from the politics of this. 

Another editorial against the program appears in the Sarasota Herald Tribune.   

And a chiropractor (and past chair of the Florida Board of Chiropractic Medicine) tries to set the record straight in the Orlando Sentinel.  As he states:

One of the more egregious claims is that prominent members of the Florida Legislature circumvented the Board of Governors -- the new governing body for the State University System -- and ramrodded the chiropractic school through the political process during the 2004 legislative session. This is sadly distorted.

Final plans and funding for the school were approved by the Legislature and signed by the governor in March 2004. Planning and work on the school dates back nearly 10 years, starting with successful efforts to establish an endowed research chair in biomechanics and chiropractic at FSU in 1995. In 1999, the Legislature directed the Board of Regents to study the chiropractic-school issue, and a report was published in February 2000, with subsequent appropriations made to FSU in both 2000 and 2001.

Recently approved medical schools at both FSU and the University of South Florida were created in a similar fashion.

The impetus for a chiropractic school at FSU was the result of a specific request by the university.

And sublaxation is support by scientific evidence too. 

Who on FSU's faculty wants this????

FSU Provost Larry Abele is quoted in this CNN story.  He says the following about FSU's chiropractic proposal:

"There's a small number of faculty who would like it to happen, there is another group of faculty who would like it to die as painful a death as possible, and then there's another group that has a lot of concerns that they would like answered before anything else happens," provost Larry Abele said.

FSUblius is curious:  Who exactly are the faculty "who would like it to happen"?  The faculty Senate Graduate Policy committee voted 22-0 not to let the chiropractic proposal go forward without serious faculty consideration, and no one on that committee expressed positives about the proposal.  So far, every indication is that FSU's faculty is strongly opposed to the proposal.  Back in December, several faculty raised concerns with the local media, and it is reported that hundreds signed an early petition in opposition.  One faculty member drew up a now infamous parody map of campus, which has been reprinted in several newspapers and magazines.  Several faculty members spoke up at the Graduate Policy Committee meeting and at the faculty forum, and have been quoted in the media as being opposed to the chiropractic school.  The chiropractic interest goups are attempting to paint opposition at FSU as based in the medical school and "out of state" interests, but in fact many faculty members outside of medicine, from math to chemistry to psychology and biology, have raised concerns with this proposal at FSU.  As far as FSUblius is aware, although several faculty have publicly conceded that they use chiropractors and that the treatment works for them (this kind of support was voiced at the Faculty Forum), not one  single faculty member at FSU has voiced support for the chiropractic proposal as it is currently drafted.  If this is incorrect, perhaps a reader can identify the faculty members who support it??????

Last Friday the Tallahassee Democrat ran a full page ad in opposition to the chiropractic school, which was signed by the following sample of distinguished faculty at FSU.  FSUblius understands that many additional faculty joined the petition too -- but the main objective was to present a balanced set of perspectives from the highest levels across many disciplines on campus.  There is so far no evidence to support the claim that members of FSU's faculty want this to happen.

Robert Schrieffer, Nobel Prize in Physics,
University Eminent Scholar in Physics

Sir Harold W. Kroto, Nobel Prize in Chemistry, Eppes
Professor of Chemistry and Biochemistry

Karen J. Berkley, McKenzie Professor of Psychology

Janet G. Burroway, Lawton Professor of English

Gregory R. Choppin, Lawton Professor of Chemistry and
Biochemistry

Timothy A. Cross, Earl Frieden Professor of Chemistry
and Biochemistry

Joseph Dodge, Stearns Weaver Miller Weissler, Alhadeff
& Sitterson Professor of Law

John G. Dorsey, Katherine Blood Hoffman Professor of
Chemistry & Biochemistry

Marc E. Freeman, Lloyd M. Beidler Professor of
Biological Science

Philip Froelich, Eppes Professor of Oceanography

Werner Herz, Lawton Professor of Chemistry and
Biochemistry

Adam Hirsch, David M. Hoffman Professor of Law

Kurt Hofer, Lawton Professor of Biological Sciences

Robert Holton, Matthew Suffness Professor of Chemistry
and Biochemistry

Michael Kasha, Lawton Professor of Chemistry and
Biochemistry

Marie E. Krafft, Martin A. Schwartz Professor of
Chemistry and Biochemistry

T. N. Krishnamurti, Lawton Professor of Meteorology

Alan G. Marshall, Kasha Professor of Chemistry and
Biochemistry

Kent Miller, Emeritus Professor of Psychology

James J. O'Brien, Lawton Professor of Meteorology and
Oceanography

Michael Rashotte, University Distinguished Teaching
Professor of Psychology

Jim Rossi, Harry M. Walborsky Professor of Law

Leo Sandon, Distinguished University Teaching
Professor of Religion

Joseph B. Schlenoff, Leo Mandelkern Professor of
Chemistry and Biochemistry

Jayaram Sethuraman, Lawton Professor of Statistics

Raymond K. Sheline, Lawton Professor of Chemistry

James C. Smith, Lawton Professor of
Psychology/Neuroscience

De Witt Sumners, Lawton Professor of Mathematics

Fernando Teson, Tobias Simon Eminent Scholar of Law