Taiwan Today

In recent years, a growing number of people in Taiwan have suffered from back, shoulder or neck pain due to increased computer use, lack of exercise and stress. Looking for alternatives to surgery and drugs, many patients are turning to chiropractors—medical specialists who treat and prevent disorders of the neuromusculoskeletal system, especially spinal problems, mostly through hand manipulation and therapy, rather than surgery or drugs. But the profession of chiropractic is facing unique challenges in Taiwan as the government does not yet recognize the field as a medical practice and currently lacks a mechanism to license chiropractors, which make it difficult for these professionals to practice freely and openly here. Shih Chung-liang, director-general of the Department of Health’s bureau of medical affairs, said since there are no chiropractic schools in Taiwan, there is no way for the department to assess chiropractors’ training and to license them. “For chiropractors to be licensed by the government, they need very formal education and training. We also need to be able to test the quality of their training, and so on, before we can license them,” said Shih in an interview. “In Taiwan at the moment, such conditions simply do not exist, because we have no education or training for chiropractic in our country. There isn’t a mature environment for us to pass a law to give them a license.” All legitimate chiropractors practicing here were educated overseas. Shih rejected the idea that Taiwan should simply accept overseas-trained and licensed chiropractors. This problem has given rise to a situation that may be hurting patients, preventing them from having easy access to a treatment method respected by the World Health Organization and whose benefits are recognized worldwide. Jeffrey Chen, a 72-year-old avid tennis player who was once a captain of Taiwan’s team to the Davis Cup, said following an injury to his hamstring muscle and ligament, he went through a series of neurosurgeons, neurologists, acupuncturists and “tui na” masseurs, but still could not stand up straight and was still in pain. Neurosurgeons several times tried to schedule him for spinal surgery, but he was skeptical. Only through a friend did he learn of chiropractors. After two months of intense treatment by David Chen, a U.S.-trained chiropractor in Taipei, who focused on restoring the muscles’ flexibility, Jeffrey Chen considers himself 95-percent recovered. “Some of the different postures Dr. Chen had me in were very painful and I had to cooperate, but after 20 sessions, I can now stand up straight, go hiking, play tennis and play golf,” said Jeffrey Chen. “I tell my friends ‘Don’t just blindly get surgery without first understanding what the problem is.’” Worldwide, chiropractic is one of the fastest growing medical fields as people increasingly turn to alternative medicine to heal problems such as back pain, curved spine, muscle sprains, scoliosis, disc herniation, spondylolisthesis and degenerative joint disease. According to industry estimates, there are more than 100,000 chiropractors globally. In the United States alone, over 30 million visits are made to chiropractors each year. But since chiropractors are not considered doctors in Taiwan, Shih said, they do not have the right to diagnose or treat patients. Only physical therapists and occupational therapists can do so, said Shih, adding that if chiropractors were to do such work, they could be fined. Health department officials said they are not opposed to chiropractors doing back soothing or adjustments, and insist chiropractors call themselves "spinal back pressers" or "back soothers" instead. But chiropractors said chiropractors, not physical or occupational therapists or orthopedic surgeons, undergo extensive training on treatment of spinal problems. In the U.S., most back problems are treated by chiropractors. Also, to graduate in the U.S. with a chiropractic degree, chiropractors have to undergo nine years of training, more than medical doctors, who usually complete in seven years. Chiropractors said the issue ultimately boils down to giving consumers a wider choice of quality healthcare. Not recognizing the profession means consumers cannot easily access chiropractors or they unknowingly seek the services of fake “chiropractors,” local chiropractors said. Shih, however, said a school must be set up or existing schools have to offer chiropractic training before the government can evaluate and license the practice. He suggested that perhaps local schools do not yet see a need to create such a program due to insufficient demand. “We won’t actively help push for such an academic program, but we really hope this will happen,” said Shih. But chiropractors said it is difficult for them, already struggling to maintain their business given the difficult circumstances, to open up a school. Such a school would also need the backing of the DOH and medical universities, they said. Chiropractors noted that Hong Kong and mainland China found a way out of similar conundrums by first legalizing chiropractic. To U.S.-trained chiropractor Mark Griffin, chiropractors have a lot to offer Taiwan, especially when Taiwanese people are interested in chiropractic. “Taiwanese people should have the freedom of choice in healthcare,” Griffin said. “The WHO recognizes that chiropractic doctors have a lot to offer the world. Why not Taiwan?” —Cindy Sui is a free-lance writer based in Taipei. Copyright © 2009 by Cindy Sui