WE ALL KNOW OUR OWN STRUGGLES for recognition as a medical profession in the United States — but many of us are not as familiar with some of the battles chiropractic is facing overseas.
Although international acceptance of chiropractic has improved dramatically over the past few decades, some nations still routinely harass, penalize and even imprison doctors of chiropractic (DCs) for practicing. Surprisingly, these are not emerging nations, as one might first think — in fact, the two worst offenders are South Korea and Taiwan.
In the 1990s, the practice of chiropractic was unregulated and regarded as the illegal practice of medicine in major European countries such as France, Italy and Spain, where DCs were occasionally arrested or fined.
Now, however, “many of these countries have laws that recognize and legalize chiropractic practice,” says David Chapman-Smith, who retired July 1, 2014 as secretary general of the World Federation of Chiropractic (WFC), based in Toronto. “As a result, chiropractic is better known and has more patient support. There is also more evidence for, and medical acceptance of, spinal manipulation. Therefore, the medical monopoly is being challenged by patients who want more alternatives for many of their healthcare needs.”
Today, formal legislative recognition and regulation of the practice of chiropractic exists in more than 50 countries. In South Korea and Taiwan, however, the medical profession has great influence over government and has relentlessly lobbied to have chiropractic declared the illegal practice of medicine.
“Complaints to the authorities are coming from medical and oriental-medical trade organizations, not patients or the public,” adds Chapman- Smith. “In South Korea, for example, most healthcare facilities, including hospitals, are privately owned by medical practitioners. DCs are accused of practicing medicine without a license, simply because they provide a diagnosis/assessment and offer treatments.”
Manipulating the Market
Basically, the medical and oriental-medical trade organizations in South Korea and Taiwan don’t want to share the market with DCs.
In South Korea, these negative forces are the Korean Medical Association (KMA), representing the medical profession, and the Oriental Medical Doctors’ Association (OMDA). These doctors (OMDs) provide their own manipulation techniques called “chuna” (taken largely from chiropractic textbooks), as well as herbal remedies and acupuncture.
“The KMA and the OMDA have been reporting chiropractors to the police since the first Korean chiropractor, Dr. Yong Serb Song, returned to South Korea from Palmer College in the early 1990s,” says Chapman-Smith. Dr. Song, the founder of the Korean Chiropractic Association (KCA), was convicted three times before he passed away in 2001.
Over the years, DCs have continued to face prosecutions and convictions. The first conviction bears a fine of $1,000; the second carries a fine of $5,000; the third prosecution likely results in a prison sentence. This situation has compelled many South Korean DCs to leave the country and practice elsewhere, especially in Australia, Malaysia, Singapore and the United States.
Dr. Taeg Su Choi, a 1998 graduate of Life Chiropractic College, took over the presidency of the KCA in 2003 and has since suffered repeated prosecutions and fines. He could face imprisonment if there are any additional convictions. Dr. Choi continues to practice and so remains at peril. Two past presidents left the country to avoid imprisonment for purportedly practicing medicine without a license.
In July 2010, five of the nine judges in the Constitutional Court ruled that Koreans had the constitutional right to practice and receive forms of alternative medicine such as acupuncture and chiropractic. However, a majority requires six votes, so this proposal fell short by only one vote. New complaints and prosecutions against KCA members have continued since this decision was made and several DCs are currently appealing their convictions to the Constitutional Court.
The Korean Chiropractic Association website states, “The life of a member is not easy. Even now many doctors are still thinking about going back to the USA. Other doctors are still practicing chiropractic and are struggling to make [chiropractic legal] in Korea.”
In Taiwan, substantial fines are levied against DCs who use the word “chiropractic” or “doctor of chiropractic” in their practice, or who engage in diagnosis, which is deemed a medical act under Taiwanese law. “When I was last in Taiwan in 2005, I visited a typical chiropractic practice, where X-rays and other diagnostic records were hidden inside what appeared to be normal living room furniture to any visiting inspector,” says Chapman-Smith.
As described in the WFC’s December 2013 quarterly report, Dr. Rai Lin, a young Palmer West graduate practicing in Taichung, was fined approximately $1,700 in November for calling himself a doctor of chiropractic on his Facebook page. In another case, the Taiwan Chiropractic Doctors’ Society’s former president Dr. Albert Lee was fined a similar amount because his website was considered a medical advertisement by the health authorities. “I was banned from using words such as chiropractic, chiropractic doctor, pain, joint, spine, any treatment methods and modalities and any health-related terms at my website,” says Dr. Lee. “Basically, the view of the Taiwan health authorities is that it is illegal for chiropractic doctors to talk about chiropractic or call themselves a chiropractic doctor on the Internet.”
Although fines and arrests have been challenged in court in both countries, none have been successful.
The Korean Chiropractic Association (KCA) and the Taiwan Chiropractic Doctors’ Society (TCDS) have ongoing legislative campaigns that are trying to improve this situation. They are helped by the World Federation of Chiropractic and other associations in the Asian region.
“I think it is important for our profession to know that these prosecutions are still happening in 2014,” says Rick McMichael, DC, secretary/treasurer for the WFC and past president of the American Chiropractic Association. “My awareness of these serious challenges for DCs has been heightened during my service on the WFC Council as an ACA representative.”
The KCA and WFC have held two legislative hearings at the Korean National Assembly in recent years to support the legalization of chiropractic. The WFC has also held high-level meetings with the minister of health and other senior officials in Taiwan. “Movement is slow, but as in many other countries, the profession will win in the end,” says Chapman-Smith. “We should be proud of the chiropractic pioneers in these countries who are risking much and working so hard.”
The WFC was also the driving force behind the World Health Organization’s policy that urges all of its member national governments to recognize and accept chiropractic as an important part of overall national healthcare systems (WHO Guidelines for Basic Training and Safety in Chiropractic). Several countries have recognized chiropractic as a result of this direction from WHO, most recently the Philippines.
“This is an excellent example of the important role that WFC plays in supporting chiropractic around the world,” adds Dr. McMichael. “WFC leaders attend the World Health Organization Assembly in Geneva, Switzerland each year to meet with leading officials from countries such as Taiwan and Korea. Last year Dr. Choi was with the WFC delegation, which met with the Korean Minister of Health Chin Young and other officials who acknowledged a problem that needed to be resolved. WFC leaders will remain vigilant for additional opportunities to assist until these challenges are resolved.”
How You Can Help
There are several ways that individual DCs in the United States can support the chiropractic movement in South Korea and Taiwan.
The most important is refusing to accept any invitations from non-DCs to teach technique or other seminars in these countries. “It is these non-chiropractors — typically physiotherapists and oriental-medical doctors — who are opposing recognition and legalization of chiropractic practice and promoting prosecution of DCs,” says David Chapman-Smith.
Another is financial support. On its website, the Korean Chiropractic Association asks for donations: “We continue to face very large legal and legislative costs and court fines as we fight to establish the chiropractic profession in Korea.” Donations can be made at www.chiro.or.kr/index_eng.html.