Mr. Richard Brown:

I thank the Chairman and members of the committee for permitting me to address them briefly today on the international perspective as it relates to this issue. The World Federation of Chiropractic, WFC, is the global voice of the chiropractic profession. We represent the national associations of chiropractors in over 90 countries, spread across seven world regions. Our role is to advance the chiropractic profession and to promote high standards of education, conduct and practice.

Members will have heard that there are some 110 chiropractors in the CAI. Members may regard the profession as small but, in a global context, they will note there are upwards of 110,000 chiropractors in the world today. Most of these are clinicians caring for patients and their communities. Others are researchers, academics, health policy experts or public health advocates. Chiropractic, therefore, is an established, respected and valued global health care profession.

Since 1997, the WFC has been an NGO in official relations with the World Health Organization, WHO. As members already heard, the WHO recognises chiropractic as a primary contact healthcare profession. Back in 2005, the WHO published guidelines on basic training and safety in chiropractic. These guidelines clearly set out the requirements of chiropractic educational programs, which include training on radiation protection, radiography and radiology. They set out practical training in the taking of X-rays and interpretation of X-rays. It should, therefore, come as no surprise that the safe and effective use of ionising radiation in the form of X-rays is a core component of every single chiropractic training programme around the world.

Quite rightly, members will all wish to be satisfied as to the quality of education of chiropractors. As they have already heard, chiropractors undergo minimum of four years' full-time education at masters level. Thousands of hours of basic science and clinical sciences training form the curriculum, and competency is tested at every stage. Upon graduation, chiropractors engage in continuous professional development, quality improvement measures and auditing of their work.

Chiropractic is offered at over 40 educational institutions worldwide. Three of these programmes are in the United Kingdom, namely, at AECC University College, the University of South Wales and BPP University. A fourth, at London South Bank University, will open its doors later this year. These programmes are both nationally and internationally accredited, ensuring quality assurance at a number of levels.

Let us return to the issue of X-rays, a critical component of effective and accurate diagnosis. In the world today, over 85% of practising chiropractors exercise their competency in taking X-rays, interpreting X-ray films and referring for diagnostic imaging, including X-rays. Chiropractors in every one of the 50 states in the United States, every province in Canada, every territory in Australia, and in England, Scotland, Wales and Northern Ireland are entitled to take, read and order X-rays. They take the role of employer, practitioner, operator and referer.

In the United Kingdom specifically, a 2006 multi-stakeholder document, Clinical Imaging Requests from Non-Medically Qualified Professionals, contained the policy statement from the Society and College of Radiographers. It stated it is perfectly in order for radiographers to accept requests from non-medically qualified referers provided the referer is adequately trained and remains competent to refer, and provided that there are written local agreements and protocols. In the same document, the General Chiropractic Council, which is the regulator, stated chiropractors are autonomous primary healthcare practitioners competent to provide diagnostic triage. The majority are fully trained to take as well as interpret images and interpret reports from radiologists. It is stated that when requesting imaging protocols they will provide a clear diagnostic rationale based on a well-founded clinical impression.

Back pain is the single biggest cause of disability on the planet. Chiropractors manage musculoskeletal disorders, including back and neck pain, at all stages of the life course. Their judicious use of X-rays plays an important role in directing safe, effective care.

My colleagues around the world, not least those in the United Kingdom, United States, Canada and Australia, many of whom trained alongside CAI chiropractors, are shaking their heads in dismay over the prospect of Ireland seeking to prohibit chiropractors, as highly trained skilled health professionals, from exercising their scope of practice and competency. The WFC respectfully submits that to do so cannot be in the best interest of either patients or the public.