An Open Letter to Life University Students and Graduates from a Life Graduate: aljbotnick@yahoo.com July 5, 2002 Following the recent loss of accreditation by the Council on Chiropractic Education (CCE), and given the agency's lack of disclosure of the exact violations cited, many students have requested help in making sense of what is going on. Being a 1996 graduate of Life University, I have followed its downward spiral over the past few years and at this time have decided to disclose information that I feel is needed to protect the public welfare and help current students evaluate their situation. Regarding patient safety concerns, several violations cited in the 2001 CCE site visit report involve patient safety. I feel that the continued operation of the Life University public clinics directly jeopardizes the welfare of the clinic's patients, including students who may be misdiagnosed, inappropriately treated, and receive unnecessary x-rays. As I see it, the fundamental problem with the chiropractic training provided at Life University is that students are taught to prematurely assign a pseudodiagnosis of "subluxation" based on speculative criteria that fail to rule out other possible diagnoses based on the patient's complaints. Students are taught the incorrect idea that the examination procedures used by the Life University clinics are valid and definitive for establishing a diagnosis. As a result, students mistakenly believe that it is not necessary for them to rule out conditions other than vertebral subluxation. However, the examination procedures taught by Life University are unsubstantiated and do not lead to rational assessment. This system originates from Life University President Sid Williams' practice-management company Dynamic Essentials. It specifies that all patient complaints should be assumed to be caused by vertebral subluxations and undergo chiropractic treatment regardless of condition. Condition-specific testing is not ordered or performed so that red flags necessitating referrals are not raised that would result in loss of business for the chiropractor. Sid Williams instructs: "It is your primary responsibility to accept that patient if they have a vertebral subluxation, even though the deviation from the normal observations are there that would indicate a referral." Sid Williams, The Meadowlands Experience, 1989, D.E. International, pp.43-44. "I accept all cases regardless of the condition. Now when you do that, what kind of potential do you got in your little town of four or five or ten thousand people...what do you see? All this potential." Sid Williams, Ibid p.77. Boilerplate examination procedures are used to avoid diagnosing patients with conditions that would necessitate a referral. Instead, all patients are inappropriately and prematurely diagnosed as suffering from vertebral subluxations - and are qualified for treatment. This system is highly unethical because the diagnostic procedures used have not been proven to be valid for establishing the diagnosis. In 1997, Edward F. Owens, Editor of the Life University Chiropractic Research Journal, commented on the lack of substantiation: "We have still not tackled the challenge of validating our own unique chiropractic clinical and research measures.... Also still lacking are demonstrations of the reliability and validity of measures of the direct neurological effects of the subluxation." Edward Owens, "Follow Your Leaders", Chiropractic Research Journal, Volume 4, Number 2, 1997. Instead of teaching students to use established differential diagnosis methods, the Life University administration substituted this questionable system. This switch has prevented students from realizing that the methods taught are inconsistent with current practices. In 1997 Sid Williams commented on the lack of foundation for his "separate and distinct" system: "I would like to see more work done emphasizing the fundamental ability of chiropractic to facilitate optimal homeostasis in the body and hence its wellness. Such research would help us establish our position as a separate and distinct health care modality." Sid Williams, "Researching the Role of Chiropractic in Improving Homeostasis", Chiropractic Research Journal, Volume 4, No. 2, 1997. The 2001 CCE site visit inspection report that resulted in probation confirms that this is exactly what was done. The inspectors concluded that patients were being misdiagnosed, inappropriately treated, subjected to unnecessary x-rays, and that the rights of research subjects were not being adequately protected: 1) "The team observed evidence of inadequate assurance of doctor of chiropractic degree candidate identification of the pathophysiologic process responsible for the patient's clinical presentation and natural history of the disorder. The Life University, School of Chiropractic, Clinician Handbook reflects that the "Principal Finding," the vertebral subluxation, is the primary cause of the patient's chiropractic problem. All patient charts reviewed revealed primary diagnoses of subluxation." -Life University Letter of Response to CCE Site Visit, May 16, 2001, p. 40) 2) Reasonable assessment and patient care plans are not reflected in a "SOAP" format as outlined in the Clinician Handbook. The team observed substantial evidence of care plans that were not consistent with the diagnosis and the pathophysiology and/or natural history of the disorder. Out of thirty random patient files reviewed most patients had a plan of care for twenty or more adjustments. In the patient files the majority presented for "wellness" care. Life University Letter of Response to CCE Site Visit, May 16, 2001, p. 42. 3) "The program was unable to provide evidence that assures doctor of chiropractic degree candidates demonstrate an understanding of the clinical indications for and the relative value of diagnostic studies. Moreover, there was no evidence of demonstrating understanding of federal and state regulatory guidelines governing procedures and the use of equipment employed in diagnostic studies." -." -Life University Letter of Response to CCE Site Visit, May 16, 2001, p. 39. 4) "The team is concerned that the protocol for mandatory x-rays results in unnecessary exposure of patients to ionizing radiation. The team recommends that the clinic modify its x-ray protocol to allow for more selective application of radiographic imaging based upon clinical findings." -Life University Letter of Response to CCE Site Visit, May 16, 2001, p. 87. 5) "Patient files reviewed reflect signs of blood or glucose in urine without evidence of a more sensitive or specific assessment-Life University Letter of Response to CCE Site Visit, May 16, 2001, p.41. 6) "The team is concerned that the quantitative clinic requirements relating to interpretation of clinical laboratory data are not being met. The team recommends that the program provide students with the appropriate opportunities to correlate laboratory results with patient data to fulfill the required number of interpretation experience." -Life University Letter of Response to CCE Site Visit, May 16, 2001, p. 68, 87. 7) The team recommends that the clinic modify its x-ray protocol to allow for more selective application of radiographic imaging based upon clinical findings. -Life University Letter of Response to CCE Site Visit, May 16, 2001, p. 69. Endangering and defrauding patients for the sake of profits is the most serious betrayal possible for any health care professional. Keeping this in mind, I am appalled by a 1989 statement from Sid Williams that advises clients (including students) that their concern for potential patient injuries as a result of the failure to diagnose should not concern them: "'I'm asking you: what do you want? What do you really want to do? Do you want to be afraid every time you adjust a patient, because you don't know what's wrong with him? What kind of disease does he have? They've all got diseases. The minute we're born aren't we going downhill? How many people have been here a long time? I notice a lot of my friends; they keep disappearing. Do you know what I'm saying?" Sid Williams, The Meadowlands Experience, 1989, DE International, p.20. I personally feel that these statements indicate extensive corruption within the administration of Life University. That sentiment combined with the CCE observations that faculty are unqualified and the curriculum is inadequate lead me to recommend that all students should limit their losses (and financial support of this administration) by immediately disassociating themselves from Life University.