VISIONARY LEADERSHIP IN REGULATION 16TH ANNUAL JOSEPH JANSE, D.C. LECTURE FCLB MAY 5, 2006

Federated Licensing Board Officers, Fellows and Delegates, Chiropractic and Consumer Members and State Regulators, National Board of Chiropractic Examiners Officers, District Directors and Delegates, Chiropractic College Presidents and representatives, Association Past and Present Officers, honored guests and FCLB and NBCE Staff:

I am humbled and honored to speak to you on this 80th Anniversary of FCLB. Although I am the 16th presenter of the Annual Janse Lecture, and the topics of my predecessors have been in-depth and profound, my purpose today is to provide insight as a regulator of 10 years, an officer and Past President of the American Chiropractic Association, a current member of the Board of Health in the State of Nebraska and most of all a practicing doctor of chiropractic for over 33 years.

I challenge you today to invoke your leadership skills as the theme of this years Annual Meeting in the spirit of which Dr. Joseph Janse devoted his life for the chiropractic profession. As you are aware, your most important position in protecting the public is your greatest challenge, while realizing, protecting the public cannot be done without protecting the chiropractic profession.

Since many of you only know the pioneer and icon Dr. Joseph Janse by name, let me tell you briefly a little bit about this man, visionary leader and doctor of chiropractic. Dr. Janse spent from 1934 through the mid-1980’s at National College of Chiropractic, now National University of Health Sciences. Through his Presidency of 40 years he took National from private ownership to non-profit status and full accreditation for both the Bachelor of Science and Chiropractic degrees. National was the first chiropractic college to do so. An undaunting task for any institution, all fueled by one man through visionary leadership.

Dr. Janse, along with his educational endeavors, was also inherently involved in the organizational activities of the profession. He was

1 instrumental in the formation of the Council on Chiropractic Education, the establishment of the National Board of Chiropractic Examiners, and the American Chiropractic Association’s Councils on Roentgenology, Orthopedics, Neurology, Physiological Therapeutics, and Nutrition. He was a chiropractic clinician with 11 state chiropractic licenses and a Diplomate in the American Council on Roentgenology, the current Council on Diagnostic Imaging.

Yet he is probably best known for his mastery of the English language and his eloquent speaking abilities which left those in his audience touched by his passion, delivery and his tireless efforts to work for the chiropractic profession, which he devoted his entire life, even at the sacrifice of his beloved family.

Dr. Joseph Janse was my mentor and my hero. I stand before you today because of the message he carried to each and every student at National College to join their local, state and national associations and to give back to this profession to which we all owe so much. “No man is an island, entire of itself; every man is a piece of the Continent, a part of the main.” Said John Donne. That is why many of you are here today---because you hold the same ideals and dedication for the patients and the chiropractic profession we serve.

In reverence to Dr. Janse, I do not want to relive the disappointment, hurt and anger that was present one year ago at the Annual FCLB/NBCE Meeting. Rather, I bring healing and solutions through visionary leadership in the spirit of and in a manner in which Dr. Janse would be proud. “One should examine oneself for a very long time before thinking of condemning others.” said Moliere.

During the ten years that I served as a member of the Chiropractic Board of Nebraska, I witnessed the struggle and the difficulties at each Annual Meeting of the FCLB and NBCE.

Those struggles continue here today. If you are tired of the emails, accusations and battles, you have the power and authority to make informed decisions in order to preserve the credibility of the NBCE examinations and demand accountability of your elected officials. It is the right time to do the right thing for this profession and not succumb to political pressure. Full accountability, transparency, disclosure and equitable term limits for incumbents, as well as newly elected officers, will strengthen the NBCE as well as moving it beyond the ongoing division and time wasting struggles for power and control. ”You see disgust and resolve are two of the great emotions that lead to

2 change,”…Jim Rohn. If you have heard “the whisper”, as I have heard “the whisper”… you should understand. The question you need to ask yourselves is …Why?…why is there resistance to making the changes and following standardized accountability procedures?

We know that change is inevitable, but that progress, many times, comes slowly. The patience and persistence and the congeniality of individuals in this profession like Dr. Janse should serve as a stimulation and encouragement to persist. Winston Churchill once said in World War II, “You can always count on the Americans to do the right thing after they have exhausted all other possibilities.” I believe that quote is applicable to the chiropractic profession today. We will do the right thing for the right reason. “If not now---when?” asked Hillel.

I utilize a tool called “processing an idea” that came to me from Dr. Kenneth Luedtke, former ACA President, to help build team spirit in my office. Processing an idea refers to the fact that all individuals who are involved with a change need to have the same time and availability of thought to understand and accept any change. It is not fathomable to bring individuals together once a year at this Annual Meeting and ask them to accept an idea that others have been processing all year. I have high hopes that the ground work that has been laid and the eventual NBCE By-Law changes will be a step in the right direction. We have far too many battles looming over the horizons to continue to waste time on these issues when we should be preparing and protecting this profession for our survival. Martin Luther King, Jr. said, “We must learn to live together as brothers or perish together as fools.”

Just as the United States Congress passed a law limiting the President of the United States to two terms following Franklin D. Roosevelt’s unprecedented 4th term, so will this Body make changes for the betterment of it’s organizations in the future.

THE COURAGE OF INTEGRITY The highest courage is to dare to be yourself in the face of adversity. Choosing right over wrong, ethics over convenience, and truth over popularity…these are the choices that measure your life. Travel the path of integrity without looking back, for there is never a wrong time to do the right thing. ---Successories

3 Now, ladies and gentlemen, our task at hand! Where do we stand in healthcare today as a profession and why? I maintain we are where we are today because of choices we have made and where we have concentrated our thoughts and efforts. As Earl Nightingale, the famous radio commentator, pointed out in his audio program, “The Strangest Secret”, it is a law of nature—“We become what we think about”.

Just last year, after 110 years, this profession has finally agreed for the most part on an identity. Because we have concentrated and thought about our differences rather than our similarities, and because we have spent countless hours, days and years in discussions and meetings about our differences, we have failed miserably to promote this great profession. Unfortunately, the great majority of the public remains as unfamiliar with chiropractic today as they are about the popular Japanese numbers puzzle Su Doku.

You may question, and you should, how does my presentation today involve you as regulators and members of your respective Boards? How can you, through visionary leadership, draw upon the history of regulation and the visions that were put forth by Dr. Janse?

First a history lesson: The first state-level professional regulation in the United States was accomplished through Virginia’s Medical Practice Act in 1639. It was not until the late 1800’s, however, that state licensure activity began in earnest and by 1900 most states had licensed attorneys, dentists, pharmacists, physicians and teachers.

Keep in mind that this profession, which had it’s beginning in 1895, spent the first 18 years as a fledgling profession and attained the first Law regulating the practice of Chiropractic in 1913 in the great State of Kansas. Therefore, between 1900 and 1960 most states granted licensure to 20 additional groups including accountants, nurses, real estate brokers, barbers, chiropractors and funeral directors. This is a key factor for the chiropractic profession. That time lag has affected us detrimentally throughout our 111 years of existence.

As regulators, you are aware that licensure is intended to protect the public by screening out individuals who would do harm and disciplining those who have inflicted harm. The basic question still remains—who benefits most from licensing…the public or the regulated profession? Requests for licensure rarely come from an outraged public seeking to end some intolerable abuse. Typically they are made by professional and occupational associations acting on behalf of their members.

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Proponents of licensure frequently argue that licensure is needed to protect the public’s health, safety and welfare. The actual result of licensure, however, may be that the licensee’s are the beneficiary of the law. Licensed practitioners gain an exclusive right to deliver services. They may then ask the Board, made up of fellow practitioners, to use its powers to restrict entry into the field by setting high education and experience requirements, giving difficult tests and erecting barriers to keep out practitioners from other states.

Thus, the licensed group may establish monopolistic conditions that enable it to control the availability and cost of services and restrict competition by prohibiting advertising and competitive bidding. If these practices exist they may raise costs to consumers without necessarily providing the public any additional protection. In chiropractic, I recognize the visionary leaders and the NBCE in their foresight to eliminate most of these barriers through standardized testing.

The position that each of you has accepted as a regulator should not be taken lightly and requires never ending diligence to work for the protection of the public and to serve the profession. One of the major problems that we experience in Chiropractic as we have moved into Federal programs, i.e. Medicare, DoD and the VA is the variation and differences of standards and scope of practice in the various States. “The great pleasure in life is doing what people say you can not do” said Walter Bagehot. Yet in chiropractic we have done just that, by gaining access and inclusion in these federal programs. B.J. would be proud!

As part of your charge today, and the vision that we must have for the future, I ask you to concentrate your efforts on standardization of licensure and scope of practice throughout the United States. The battles we have fought gaining licensure state by state have left this profession scarred and fragmented and remain as a barrier that only you can seek to remove in a unified manner.

FCLB efforts towards clinical competency through the PACE program and presentations on Ethics currently being given by FCLB President, Dr. Ed Weathersby, are to be commended. Unfortunately, we must continue to deal with disciplinary actions against practitioners who fail to follow ethical practice standards and who jeopardize this profession and put the public, we are to protect, at risk. Your diligence in disciplining these practitioners, your peers, cannot be understated.

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Until the colleges assume the responsibility at matriculation, as well as throughout a student’s education, of weeding out those who would practice chiropractic only for material gain, you will have to continue to provide discipline to those who abuse their privilege to practice the art, science and philosophy of chiropractic. Why is it that medical, dental, pharmacy and even physical therapy schools limit enrollment and we do not?

Another great milestone in this profession has been the inclusion of consumer members. The Chiropractic Boards, along with guidance from FCLB, should be commended for this action. When licensing boards were first formed, the philosophy was that only members of the profession were qualified to make judgment about entrance standards, examination content or disciplinary matters. Because regulation has a direct impact on the public, and to the benefit of our Boards, consumer advocacy groups have believed that the public should be actively involved in the regulatory decision making process, and rightly so. Woodrow Wilson said, “A man is not as big as his belief in himself; he is as big as the number of persons who believe in him.”

This challenge has been met and most all Boards now include public members or auxiliary personnel. The additions of individuals who are not members of the regulated profession assist the board members in more fully recognizing the needs of the public. FCLB has recognized this need by appointing a consumer member to the Board, and in so doing provide a point of view which may otherwise be absent if the Board were composed solely of licensees. FCLB is to be congratulated for that decision. I have always felt that chiropractic is far too important to be left only to doctors of chiropractic.

Sadly, our strength and our effectiveness today as a profession, has been hampered by our own history. From D.D. Palmer’s inherent brilliance and the following of his proponents and supporters, interpretations by each individual have varied, resulting in professional sectarianism. Without licensure and regulation and a singleness of direction, our profession has developed into one of varying organizations all vying for professional control. Coupled with the on slot of organized medicine protecting their hierarchy, our profession has been denied its rightful place in the healthcare field. The most recent evidence of that was the attempt to integrate a chiropractic college into Florida State University, even though chiropractic education today is definitely of the collegiate and university caliber and level. We pay homage to those in our profession who through great

6 professional sacrifice have continued to fight these never ending battles. “Let us have faith that right makes might, and in that faith let us to the end do our duty as we understand it.”—Abraham Lincoln.

In an article by Dr. Janse which was originally published in the July and August 1952 issues of the Journal of the National Chiropractic Association, he provided insight over 50 years ago for the future of this profession. And I quote Dr. Janse, “I humbly set forth a number of ideas that I sustain in relation to the future of our profession. They are presented not as mandates, but as premises to be analyzed and considered.” 1. “…the need to develop a greater attitude of professional nationalism. The day must come when all of us must find our common interest in chiropractic.” 2. “…depersonalizing our allegiances. Schools, their leading personalities and their philosophies and methods of chiropractic should all be subservient to the common cause of our profession.” 3. “…mitigating our emotional intensities. Believe me, if we are to wait until all mistakes have been rectified before we unite in support of our common cause, our profession will suffer continued division.” 4. “…we must bring ourselves to the commitment to ‘live and let live’ and to avoid the involvements of arguing and quarreling. Any progressive profession must be sufficiently fluid to accommodate itself to progress of time and change of circumstance.” 5. “…we must recognize the fact that if we are to survive we will have to acquire for ourselves certain rights so necessary to the conduct of our professional business.” 6. “…only through organization can we sustain our progress and strength. State and National organizations are so very essential to the continuance of our professional life.” 7. “…it is time that our educational institutions become subservient to our professional needs, rather than stipulators of attitudes. Graduates from all schools should be sent into the field sustaining the ethics of understanding, tolerance and unrestricted professional support. Any conduct short of this is a conduct of insincerity and is a hazard to our profession.” 8. “…realizing the fact that all schools of healing have certain things in common. Have we the right to become so exclusive in our therapeutic thinking that we recognize no virtue or possibility in anything other than the adjustment?”

7 9. “…I suggest that we become more protective of our profession. Chiropractic and its reputation have been in a very vulnerable position because of certain conducts in which we have indulged and certain inadequacies we have tolerated. We should be considerate of how we represent and portray chiropractic. People should want us because of the sincerity we possess and the good citizenry we exemplify. 10. “…we daily re-emphasize the great privilege that is ours. It is a privilege to be a doctor; it likewise entails great responsibilities.”

Sixty years ago Dr. Janse gave us his ideas in relation to the future of our profession. How much better off would we be today, had we, as a profession, been mature enough to follow his recommendations. However, it has been said by Mark Twain, “It is not worthwhile to try to keep history from repeating itself, for man's character will always make the preventing of the repetitions impossible.” We are where we are today because of choices we have made and where we have concentrated our thoughts and efforts.

Today we are not only saddled with the unfinished business of our past and our failures to mature as a profession, but now we have new challenges that we must confront and conquer.

Healthcare is being directed and changed dramatically by consumers called “baby boomers” of which I am proud to be apart. Consumers are demanding what they want, driven by media advertising, even to the extent of telling their medical doctors which prescription should be prescribed.

Sixty years ago this month the “Greatest Generation” gave birth to the first of the baby boomers following the end of World War II in August of 1945. The “Greatest Generation”, of which Joe Janse was a part, was united by the Great Depression and World War II. Their ethic was self denial. They sacrificed for the future. Consider, on the other hand, the baby boomers with an ethic of possibilities and self- fulfillment and how they can make a difference. The baby boomers expect to have an active and engaged life right up until the end. As a baby boomer I know we are younger, not just physically, but in attitude. Let there be no doubt that the baby boomers are driving healthcare.

The boomers this year, and in years to come, with their attitude of making a difference will be playing out the scenarios as predicted by

8 the Institute for Alternative Futures (IAF). This on-line poll was published in December of 2005 and made possible by funding through NCMIC Group, Inc. Each of you should have read this poll and be aware of its content. With high profile individuals such as Presidents Bush and Clinton, First Lady Laura Bush, Reggie Jackson, Cher, Donald Trump, Dolly Parton and Sylvester Stallone turning 60 this year, health care and Medicare will remain on the front burner.

The IAF (Institute for Alternative Futures) laid out four scenarios; 1. slow, steady growth 2. downward spiral 3. evidence-based collaboration 4. healthy life doctors

These scenarios afford our profession an opportunity to make a difference. We have an unparalleled opportunity to demonstrate our value in health care and to attain our rightful position as providers. Of the four scenarios, three of them provide the action steps we have been waiting for, and we need to become proactive enough to keep the “downward spiral” scenario from occurring. Our response to the predictions of these futurists will determine more than anything else the future of this profession. You, as regulators and leaders, have the responsibility in your states to implement the necessary action steps.

Leadership requires that you confront managed care organizations as well. There is no doubt that managed care as we know it today, for the most part, has been a terrible solution to the growing problem of health care costs for patients as well as for providers. As more and more states, eighteen in total now, like the pioneers Arkansas and Nebraska, and associations such as FCLB and ACA step up to the plate, we will continue to diminish the MCO’s influence and force change.

Chiropractic continues to position itself through organizations such as the Congress of Chiropractic State Associations, FCLB, NBCE, FCER, ACC, ACA, and ICA. The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) as an extension of the Congress is diligently working to provide evidenced-based care with research backed studies to promote the cost-effectiveness of chiropractic care.

Unfortunately, membership in all organizations is lacking and continues to hamper our development because of numbers of members and finances. You as leaders must belong, encourage others to belong and support all chiropractic organizations that are working to build and better this profession.

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On the other hand, we have better working relationships with carriers who choose to work with state and national associations rather than chiropractic networks directly. The future demands that we pull together as a profession and remain relentless in our pursuit of protecting our patients and chiropractic from the Judas’, known as “chiropractic networks”, in our profession who would sell us out for a few pieces of silver. I am ashamed that some of these individuals are even past Association leaders.

Your leadership also requires that you fight another front; the battle with the physical therapists. In 2000 in Seattle, David Chapman- Smith warned us that we will not be able to stop the physical therapists from performing . Rather, he recommended that we work towards forcing them to meet the educational requirements and standards that the chiropractic profession has set for spinal manipulation/adjustment.

In 1952, Dr. Janse stated, “Chiropractic, by choice, continues to maintain an independent role in the healing arts world because it fulfills a definite need, acknowledged and recognized today by other schools of healing, but practically left unattended because of their over-involvement in other areas.”

Ladies and gentlemen that scenario no longer holds true today, things have changed. The art, science and philosophy held sacred by our profession is being endorsed and utilized by other professions, the physical therapists being just one. The real danger for our profession through the doctor of physical therapy program is if the public begins to perceive PT’s as doctors as they attempt to expand their knowledge to include full diagnostic and imaging capabilities along with the use of pharmaceuticals. What will be most challenging for the PT’s will be how to deal with a majority of their profession that does not possess a DPT or a Master’s Degree. They too will deal with a strong division when that occurs.

Whether we like it or not our identity as spinal specialists is at stake. Being specialists in a particular field has not hindered the dentists, podiatrists or optometrists. We also have not pursued being rehabilitative and nutritional specialists while 3rd party payers reimburse for therapeutic exercise and other active care more than most passive care we supply through the chiropractic adjustment.

10 With our division nationally and 50+ separate and distinct state associations we will be hard pressed to continue to win that battle against the larger and undivided American Physical Therapy Association with it’s 50 affiliated state chapters with unified visions and goals. What have you done in your state to force the PT’s to meet the same standards we meet to provide spinal manipulation or to preclude them from providing Grade V mobilization, the chiropractic adjustment?

Those of you here who have been supportive, especially NBCE, know our victories in the lawsuits filed by the ACA have been difficult to come by. We currently won the appeal for the lawsuit against HHS to allow us to try the case against MD’s and DO’s as being unqualified to provide the chiropractic service under Medicare. Unfortunately, only 15% of our profession met the call to support or continue to support these lawsuits. John Stuart Mill said, “Everyone who receives the protection of society owes a return for the benefit.” Thank you NBCE for your belief and support and understanding the need to protect our student’s future.

Today, the battle continues as we fight to stop S1955. I trust that your patients and you are pro-actively fighting to defeat S1955. In addition to chiropractic organizations and associations, AARP and a strong majority of Attorneys General have also strongly opposed this bad legislation.

Perhaps our biggest battle lies in the field of public relations. Public relation campaigns were attempted as far back as the early 50’s when Dr. Janse talked about the purpose of the effort was two fold. “First, to acquaint the public with chiropractic and the therapeutic merit it presents. Second, to offset some of the medical propaganda with which the public is constantly bombarded.”

Public relations campaigns have been, at best, only minimally successful in the past. Currently with the “Foundation for Chiropractic Progress”, we now have the opportunity as a profession to back a program whose sole purpose is to bring patients into chiropractors’ offices. This unity of action is where our future lies since unity as a profession has never been achieved. Each of us must join and support the “Foundation for Chiropractic Progress”.

Unity of action has also been demonstrated at a recent Chiropractic Strategic Planning Conference, where members of the profession

11 worked in unity for a common goal identifying two priority areas that needed to be addressed: 1. Integrity and Trust. The inappropriate treatment and billing practices adopted by some members of the profession that place the economic interests of the chiropractor before the best interest of the patients undermines public trust in all members of the profession. 2. Equitable Public Support for Education and Research. There is an absence of fair and equitable public funding and other support for chiropractic education and research either in public or private institutions. Specifically, there is a lack of support within the academic and interdisciplinary environments including participation with publicly- funded universities and health care facilities.

This conference urged the chiropractic profession, and its leaders and regulators, yes regulators, to address the issue of integrity and trust and the profession and all other stake holders for equitable public support for education and research. We are speaking about unity of action.

As regulators, I ask you to be inspired today and use your leadership skills, becoming proactive, and making the tough decisions in the spirit of Joe Janse. I charge you with the following actions steps in your individual states: 1. Endorse the identity of this profession and carry that message to your individual states

2. Hold chiropractic colleges accountable with their requirements for matriculation and student ethics

3. Track offenders and profile them according to their college, technique, practice management affiliation and competency in CE hours. This profession should identify the offenders and hold them accountable.

4. Take a proactive stand on managed care organizations and care abuse such as Arkansas and Nebraska have done and 16 other states are contemplating action

5. Endorse best practices as provided by CCGPP

6. With the implementation of the PACE program, utilize Board energy by taking the offense to promote and develop the profession while protecting the public—they are one and the same

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7. Differentiate the Grades of manipulation and specify who can provide Grade V mobilization/chiropractic adjustment as was done in Pennsylvania

8. Establish and promote the criteria for low amplitude high velocity manipulation through legislation and/or regulation

9. Endorse and support the “Foundation for Chiropractic Progress” public relations campaign

10. Look for similarities with other health care professions while educating them to the differences and benefits of the chiropractic approach

11. Work with your state associations to hold doctors of chiropractic accountable and competent through CE and Mandated hours. Education makes much more sense than discipline after an infraction

12. Be cognizant of the attempts of physical therapists and massage therapists who are under trained and not licensed to provide the chiropractic service. Become proactive legislatively to protect the chiropractic service and the training necessary to provide it, as well as reporting those who practice outside their scope for disciplinary action

13. Define a program to work with doctors of veterinary medicine in relation to chiropractic care for animals

To summarize, I share with you Dr. Janse’s words as follows: “Out of our past we have garnered ruggedness and a strength that will fully qualify us for the future. The strains and the stress that we have always been under; the sacrifices that we have always had to make; the oppositions that we have had to withstand have developed a fiber of determination that will assure us eventual success. Our great need is more professional determination, more integrating intent, more mutual understanding. I have always been appalled by the greatness of our premise. We make claim to possess a therapeutic measure that is both revolutionary and extraordinary. We have developed into the second largest healing group recognized by society.”

13 Anyone who knew Dr. Janse or listened to him speak, knew of his love and understanding for this profession and his tolerance for the differences. He often quoted the poet Rudyard Kipling…

“Here’s to the men and women of my own breed, good or bitter bad, as though they may be, at least they hear the things I hear, and see the things I see.”

In closing, I have devoted my professional career to doing whatever I could to help build a profession. Inspired by Dr. Joseph Janse, I have attempted to serve my patients and this profession as a servant- leader. I thank God every day for my family, my profession and for my abilities as a doctor of chiropractic. I thank you for giving me this opportunity to do honor to my mentor as he asked me to give back. When you leave here, hold your heads high and be proud of who you are and what you do for our patients and chiropractic. And when you fight, and fight you must for this profession, say....This one was for J.J.!

May God bless chiropractic, America and those serving our country to keep us free.

Thank you,

Daryl D. Wills, DC, FICC

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