The University of Pittsburgh is launching a Doctor of Chiropractic
opens in a new tab or window program -- the first at a major academic research center -- raising some eyebrowsopens in a new tab or window in mainstream medicine.
The program will be part of the university's school of health and rehabilitation sciences, which also includes its physical therapy, rehabilitation, and occupational therapy programs, among others. It is separate from the university's school of medicine.
"This is the first chiropractic program in the United States to be offered in a public research intensive university," Michael Schneider, DC, PhD, the director of the Doctor of Chiropractic program, told MedPage Today. "It's a big deal, not just nationally, but internationally."
Currently, there are 19 chiropractic schools in the U.S., according to the accrediting bodyopens in a new tab or window of the Council on Chiropractic Education, but none of these are affiliated with a major U.S. academic center.
The University of Pittsburgh program plans to enroll 40 students in the fall of 2025, and while its curriculum is still in development, it will span eight terms, Schneider said. In a public releaseopens in a new tab or window from February, Schneider said students "will follow all public health initiatives and recommendations and will receive clinical training side-by-side in an integrated setting with physicians, physical therapists, and other health care providers."
The release also noted that Schneider has been a principal or co-investigator on many NIH-funded studies and is "currently a co-investigator on four NIH-funded clinical research studies totaling about $30 million." He practiced as a chiropractor for more than 25 years, then received his PhD in rehabilitation science from the University of Pittsburgh in 2008 before moving into academic research, according to the release.
"Chiropractic is no longer seen as this alternative, kooky kind of profession. It has enough evidence now to show that [what] we do works and it's integrated health," Schneider told MedPage Today. "It's not alternative medicine anymore, and I think that's the way it was viewed here at the university, and why the program was approved."
Mainstream medicine has moved toward wider acceptance of treatments once perceived to fall more into the realm of "alternative" medicine, particularly for therapies like meditation and acupuncture.
While many physicians still don't refer to chiropractic, there have been hints of wider acceptance, including a 2017 clinical practice guidelineopens in a new tab or window from the American College of Physicians on treating low back pain that recommended nonpharmacologic treatments, including spinal manipulation (typically performed by a chiropractor), albeit supported only by low-quality evidence. Indeed, a handful of clinical trialsopens in a new tab or window published in recent years have suggestedopens in a new tab or window a small short-term advantage over usual care for certain conditions, including low back pain.
Mainstream medical facilities including Brigham and Women's Hospitalopens in a new tab or window and its Osher Center for Integrative Health in Boston, and the University of California San Diegoopens in a new tab or window appear to endorse chiropractic on their websites. And even Medicare coversopens in a new tab or window "manual manipulation of the spine by a chiropractor to correct a vertebral subluxation," though it says it "doesn't cover other services or tests a chiropractor's orders."
Nonetheless, chiropractic has a fraught history with traditional medicine, colored in part by an effort by the American Medical Associationopens in a new tab or window (AMA) to eliminate and delegitimize the profession. Chiropractors sued AMA on antitrust grounds and won their case in 1990.
That history still shapes physician perspectives today. Joel Zivot, MD, an anesthesiologist and intensivist at Emory University in Atlanta, told MedPage Today, "Chiropractic, I think, as an activity has a pretty high rate of complaint I believe," he said. "And usually, it's bruises or twists, or in the worst case scenarios, there are herniated discs or strokes."
"What people fear about [chiropractic] is that it's yanking on a very delicate part of the anatomy, seemingly with uncertain parameters," he said.
He said he'd be more likely to refer a patient to an occupational therapist, physical therapist, dietitian, or "other allied health disciplines," rather than a chiropractor.
Another motivation by the university, Zivot noted, could be an overall shift in the healthcare marketplace. "What is the failure of allopathic medicine? Because in many ways, it has failed in its fiduciary duty to the public. Many people are unsatisfied with it."
Traditional medicine may not address various patient issues, "And so when people feel like they go to the doctor, the doctor doesn't help them, they naturally want to go somewhere else," Zivot said.
However, he said, it can be hard for patients to decipher overlapping roles in medicine, the level of training that accompanies a particular honorific, the level of risk, and cost with any given practitioner.
The school's motivation could also be financial, Zivot added: "I don't know if they've actually made some kind of an analysis, a need in the local market, or because they just decided that they can make money on it."
While the University of Pittsburgh's school of medicine declined an interview with MedPage Today, it did provide a statement from the chair of its department of physical medicine and rehabilitation.
"This new program will support capacity building for clinicians rigorously trained in evidence-based treatments, which is much needed for spine and other musculoskeletal conditions," wrote Gwendolyn Sowa, MD, PhD.
Schneider acknowledged what he called a "historic rivalry" with the field of physical therapy, but characterized chiropractic as a more specialized practice.
"Most physical therapists will treat [the] back, but it's more general," he said. "And so there's really not another profession that really has focused just on non-surgical, non-pharmacological spine management, and that's where chiropractic fits in."
The American Academy of Physical Medicine & Rehabilitation, the American Academy of Family Physicians, and the American Physical Therapy Association all declined to comment for this story.
https://www.medpagetoday.com/special-reports/exclusives/112253
