Dr. Michael Flynn with U.S. Surgeon General Regina Benjamin, at WHO meeting in Geneva, 2010.

Dr. Flynn is a 1975 graduate of Texas Chiropractic College. During the course of his career he has served as President of the Chiropractic Association of Louisiana and the Louisiana State Board of Examiners. For six years he was state delegate to the American Chiropractic Association (ACA) and he then served six years on the ACA Board of Governors, two as chairman. He was the first chairman of the National Chiropractic Legal Action Fund. He is a past recipient of the ACA Chiropractor of the Year Award and for the past eight years has chaired the Student ACA (SACA) Committee. Dr. Flynn is a member of the Board of the Foundation for Chiropractic Progress and was recently elected to the Association for the History of Chiropractic Board of Directors.

A second generation chiropractor, Dr. Flynn is the son of the late Dr. John Flynn, who practiced for 20 years in Louisiana before legal recognition of the profession, and was president of the state association in 1974 when the state became the last to license and regulate the profession in the United States.

Before we speak about your work with the World Federation of Chiropractic and the Foundation for Chiropractic Progress, could you share some of your early experiences with chiropractic?

My earliest experiences with chiropractic were as a young boy growing up as the son of a chiropractor in South Louisiana. My dad’s story is that he came home to Detroit after World War II and found that his mother, while he was gone, had suffered severe headaches. A friend had recommended that she see a new kind of doctor, who was advertising that he could help with headaches. My grandmother had been to all the medical doctors—it was one pill or potion after another. They finally told her that she just had to live with it. The doctor she went to for her first adjustment was Dr. Derifield, in Dearborn, Michigan.

When my dad came back, grandma said, “Son, I had these horrible headaches, and I went to the chiropractor, and I felt so much better. And now my headaches are gone, since he balanced my neck. I want you to consider becoming a chiropractor.” Dad had never heard the word before, but he took her advice and enrolled at Palmer. Four years later in 1954, when he graduated, B.J. Palmer, who was the president of the school at the time, told students who had not yet made a decision where they wanted to practice, to think about those four states—Massachusetts, New York, Mississippi and Louisiana—where there was not yet licensure for chiropractors. My dad and another friend of his chose Louisiana. He took mom, my two brothers and sister, and we came down to South Louisiana—50 miles southwest of New Orleans—not knowing a soul. I grew up in a time where my dad and consequently his family were subject to social and economic stress and hardship.  Ask any son of a chiropractor how many times he heard someone say, “My daddy says your daddy is a quack.” Dad always had lots of patients, but he also had days where he came home early because his friend, the sheriff, had called him to say that there were medical investigators in town, and he had to close the clinic today.

Was he ever arrested for practicing chiropractic?

In 20 years of practice, my dad was never arrested, although many of his colleagues here in Louisiana were.  Because of his friendships with several sheriffs in succession, most of whom were patients, he was always tipped off.  But he never quite knew if a new patient was an investigator from the medical board. Maybe my earliest experience was when I was 14 years old. My older brother had been killed in Vietnam months earlier, and mom took it very hard. Finally, when she got out of the house, she went to my dad’s bowling night. Within 30 minutes, they were back home and mom was visibly upset. She went into the bedroom. I asked dad what had happened. He said that there was a medical doctor bowling on the other team, and he refused to bowl if a chiropractor was there. So he made a big stink and mom just couldn’t believe that someone could treat them in such a fashion, especially after just losing a son in service to country. 

Before my mom’s passing several months ago at age 85, we had many talks about those early days. She reflected on how she had been asked by neighbors to join the local carnival club, only to be turned down because her husband was a chiropractor. She later became president of that organization. 

I grew up in that kind of environment and have many similar stories, just as other sons, daughters, husbands and wives of chiropractors could share about “bad times” in those dark days of the AMA boycott. It was especially hard during months when the legislature was in session. The “contain and eliminate” strategy was put into action by political medicine all across the country and the chairman of the AMA committee happened to be from Louisiana. So is it any wonder why Louisiana was last to license the profession?  

What else did they do?

One of the action steps by the committee was to indoctrinate medical school students about those unethical and rabid chiros. The good doctors then shared their new unfounded prejudice with their patients. One of the earliest quotes my dad had me learn was from Eleanor Roosevelt, “No one can make you feel inferior unless you give them permission.” My dad was very proactive in the profession. He was the president of the state association in Louisiana in 1974, when we finally received licensure. He had a saying when trying to encourage his beaten down and too often complacent colleagues, “How can you expect patients to support your practice if you are not willing to support your profession.” This still holds true today.

Louisiana was the last of the 50 states to license chiropractic. What happened in those final years to put it over the top, to change this longstanding injustice?

We elected a new governor, Edwin Edwards, who later would be sentenced in 2001 to ten years in jail for racketeering. Governor Edwards had a brother he was very close to and they campaigned together. His brother, Marion, had always been treated by a chiropractor for various ailments. And because of his brother, among other things, he said, “When I become governor, I am going to license chiropractors.” And he made good on that promise. Dr. Jim Parker of Parker Seminars was also a huge help in raising funds to counter all the misinformation of that time and for inspiring the doctors in the battle for licensure to never give up. In the pictures of the governor signing the law, Dr. Jim was front and center with many from the state leadership, as he deserved to be. 

You are the President of the World Federation of Chiropractic. What is the mission of the WFC and how did you first become involved?

The WFC was established in 1988 in Sydney, Australia, by bright and visionary DCs. I am one of two ACA representatives to the WFC; the other is the current ACA president, Dr. Rick McMichael. My first WFC meeting was in 2001 in Paris, and in 2004, I was elected to the executive committee in Singapore and subsequently two years later in Johannesburg South Africa. In Seoul, South Korea, in 2008, I became first Vice President. In Budapest in June 2010, I became the tenth WFC president and fourth from the United States, following in the deep footprints of Drs. Gary Auerbach, Lou Sportelli and Gerry Clum.

The World Federation of Chiropractic represents chiropractors who practice in 85 countries. Those 85 countries are all voting members of the WFC who meet every two years at the WFC Congress. In the year in between, the WFC Council meets. It is comprised of elected representatives from the world's regions.  In 2011, the Congress meets in Rio de Janiero, Brazil. At the Rio Congress we are going to celebrate a huge victory by our Brazilian colleagues, who had to fight back against a strong physical therapy association, who attempted to have a law passed that would have made chiropractic a sub-specialty of physical therapy. There’s been an ongoing battle in Brazil for many years, to preserve and protect chiropractic’s separateness and distinction. The WFC has led and supported the Brazilian chiropractors in this battle. Just several months ago, a judge ruled that one profession, even though they might be larger—there are 98,000 physical therapists in Brazil with maybe 400 DCs and two colleges of chiropractic—cannot overpower another profession just because they have more strength and resources. The judge ruled that chiropractic is a separate profession and now the fight for regulation continues in their legislative system. 

The mission of the WFC is a global perspective to unite members of the profession, protect the character and status of the profession, promote ethical practice, encourage improved standards of education and practice, encourage research and cooperate with appropriate national and international organizations. Of the 85 countries the WFC represents, almost half of them are still in pitched battles for recognition and regulation.  The WFC is in their corners against what oftentimes are great odds—kind of like what we had in Louisiana. The WFC and FCLB recently held their second joint meeting in London on issues of professional mobility and the teaching by chiropractors of chiropractic methods to non-chiropractors in unregulated countries. These are ongoing issues that both the WFC and FCLB, as well as many country representatives, are working on in earnest.

In 2005, an international conference sponsored by the WFC reached agreement on chiropractic identity. What was important about this consensus process and what conclusions were reached?

One thing to mention is that over 100 delegates from national associations in 36 countries met in this long consultation and identity process which included several surveys of the profession. We knew as an organization that the identity of the profession lacked clarity and we wanted to find consensus on some core concepts for an international identity of the profession, something the public could relate to. So after a two-year process, the identity of the profession as “the spinal health care experts in the health care system” was agreed to, along with a series of other statements that went into further detail about the identity of the profession.

Is there a need to harmonize not only the identity of chiropractic, but its legal definition and scope of practice, across national boundaries? Or, for that matter, across state boundaries within the United States?

That’s an important question. It’s an issue that we have to grapple with as a profession, both internationally and within the United States. We have 50 different states, and pretty much 50 different state laws. And the profession, sometime soon, will have to mature to a point where we have to come to a uniform agreement as to what is the practice and scope of chiropractic. That won’t be an easy process, but I believe that the Federation of Chiropractic Licensing Boards, the Congress of Chiropractic State Associations, our colleges and national associations will have to take that on at some point in the near future.

Internationally, the profession is growing in leaps and bounds and facing similar issues. Chiropractic colleges will be springing up all over the globe …

There are now more chiropractic colleges outside North America than inside North America.

Many more. Just recently, David Chapman-Smith, the Secretary-General of the WFC, was in Jordan with our previous president Dr. Stathis Papadopoulos of Cyprus. One of the leading medical universities in Jordan is very serious about beginning a chiropractic program, as are other universities in different countries that are saying, “We want a chiropractic department.” As you are aware, Kuala Lumpur, Malaysia, just began its first class a couple of months ago, at the International Medical University. They have nursing, dentistry and medicine, and now they have a chiropractic class as well. Almost all of the new chiropractic programs will be tied into established universities. 

The Council on Chiropractic Education now has an international branch, CCE-I. The National Board of Chiropractic Examiners also has an international branch, IBCE. So we are seeing great efforts to harmonize the standards of the profession, universally. They’re doing a good job with it. They are ahead of the curve, understand the issues and are making great progress. I am very proud of the work going on at those international agencies, which are offshoots of agencies began in the United States.

Internationally, where does the chiropractic profession stand today regarding the inclusion or exclusion of drugs and surgery?

I don’t think surgery comes into the equation. But there seems to be a growing interest in the use of pharmaceuticals. Surveys in North America and in Europe show a minority of DCs interested in some prescription rights. Denmark and Switzerland have prescription rights, and there may be others. So there are pockets of this precedent internationally.  The WFC has a clear policy that was passed by the Assembly in 2003, that states the practice of chiropractic does not include the use of prescription drugs. I don’t see any attempts to change that anytime soon, but I do believe that it’s an issue that in the future, our profession, internationally and in the United States, will have to have a conversation about.

Where does the chiropractic profession stand today internationally with regard to primary contact or primary care status?

Everywhere that chiropractic is practiced and regulated, there is primary contact status, and we should not settle for anything less. A good example is that several months ago, Israel finally received regulation and licensure from the government. Over a period of 15 years before this, they were offered regulation, but with the caveat that they couldn’t diagnose. They walked away from that table, unwilling to accept a substandard regulatory act. They held the high ground and were rewarded years later.

If they weren’t allowed to diagnose, would that mean that chiropractors could only see patients after a medical physician had diagnosed the patient?

Yes, this would create a technician/therapist status rather than a doctor-level status. We can’t allow unacceptable legislation anywhere in the world. The WFC stands strongly for a consistent level of legislation internationally, one that includes diagnostic rights, and that values our skills, training and education.

You and I got to know each other through work for the Foundation for Chiropractic Progress. What are the Foundation’s goals and how does it go about accomplishing them?

Kent Greenawalt, whose dad was the late, and very special, Dr. Monte Greenawalt, decided four or five years ago that the profession needed a vehicle to ensure that the public knew the benefits of chiropractic care. He wanted to do it with a marketing campaign, across the country, with one mission. That mission is positive press for the chiropractic profession. I always hearken back to the Wilk anti-trust lawsuit, 15 years in the court system. Finally in 1987, the judge found the AMA and 1900 local and regional medical societies guilty of an illegal boycott against chiropractic. In her decision, the judge remarked, among other things, that the boycott was organized, it was long-term, and it was successful in ruining the reputation of a competitor. It was revealed in the two trials that the strategy of the AMA was to “contain and eliminate” the profession. They were successful in casting a long, dark shadow over the profession by using vast resources to spread misinformation, innuendo and half-truths. 

“Contain and eliminate” were their actual words, from internal AMA documents.

That’s right, “contain and eliminate.” And another of their strategies was to encourage disunity within the profession, so that they could “watch them wither and die on the vine.” They did a number on the profession in terms of reputation. The Foundation for Chiropractic Progress is getting that reputation back, by having high-profile spokespersons like Hall of Famer Jerry Rice, Brigadier General Becky Halstead, and others, speaking out about the many benefits and significant value of chiropractic care. They have run national, well thought out ads in magazines, newspapers and publications all across our country, provided thousands of news services ongoing advertorials on conditions that chiropractors treat very successfully, which include PSAs (public service announcements) on radio and television. What the Foundation is accomplishing and has accomplished over the last four years, has never been done before in our profession. It was past due and will make a big difference in public perception. 

How is the Foundation for Chiropractic Progress funded? Do you seek contributions from practicing chiropractors and other friends of the profession?

The profession is very fortunate that Kent Greenawalt and his company Footlevelers is picking up all the operational cost for the foundation. Kent has his father’s generous passion for the profession. Every dollar raised from doctors, students, colleges, associations and vendors goes directly into the campaign of positive press. I was on the phone earlier today with the Foundation’s COO, Gary Cuneo. We were talking about students on many campuses who are rising in numbers to support the Foundation. Even with small contributions of five or ten dollars a month. They understand that the Foundation for Chiropractic Progress is setting the stage for their future success. What we were discussing was that for too many years, almost throughout our history as a profession—perhaps because by nature chiropractors are nonconformist—there are not enough chiropractors who are willing to give back to the profession, to give to back to our colleges, our state and national associations. Sadly, the Foundation for Chiropractic Education and Research, after 60 years, folded last year because of general apathy. Fortunately, there will be other organizations that will pick up that mantle for ongoing research, which will be the cornerstone of professional growth. The 80-20 rule applies, with 20% of the profession always supporting and participating and 80% silent and hiding behind one excuse after another. This has to change.

With the positive press campaign for the profession, we’re trying to inspire our colleagues, doctors and students of chiropractic, to become monthly contributors, so that we can plan our budget each month, and how much we can spend on this national campaign. Last year, the Foundation was responsible for over 500 million positive impressions of the profession, that were tracked through our PR agency, a PR agency that does their work for us, pro-bono. That’s Joseph and Laura Carabello, because they love this profession, they are both long-time patients, they understand the battle that we have in public relations, in changing the public mindset and in confronting adversaries who still want to see the profession contained and, if not eliminated, then severely restricted. 

It’s an uphill battle, but it’s a battle that has to be fought and won! Because of Kent Greenawalt and the Foundation Board, generous vendors and monthly contributors, we are fighting that battle and winning. As of today, we’re up to over 1400 monthly contributors. And while I’m not that excited about this number because it only represents about two percent of the profession, with those 1400 members, we were able to put out 500 million positive chiropractic impressions last year. We have great college support, great state association support, and great vendor financial support.  The missing step right now is our colleagues out there. We’ve got to increase our numbers, which increases the resources available, and it should not have to be a hard sell. More doctors of chiropractic and students have to understand that there are huge opportunities and unlimited potential with a nation-wide positive press campaign.

From your perspective, what are the main strengths and weaknesses of the chiropractic profession?

The strength of the profession is the uniqueness of the set of skills that chiropractors possess through their education and their training. I’ve always said that doctors of chiropractic, with their conservative and holistic approach deserve to be among the most respected of all healthcare professions because of the services they provide, services that no one else can match for the depth of their philosophy, science and art. Other professions might say they do manual manipulation or mobilization. But chiropractors—through training, methods, and techniques—stand alone in what they’re able to provide to patients who need the care that only a doctor of chiropractic can provide. That’s why our profession is so very special, why patient satisfaction studies on chiropractic care soar. And why we’re going to continue to grow and prosper—patients need our services. 

But that must be coupled with the weakness of the profession, which is that we are far too complacent given the challenges we face. Some say all the signs point to an apathetic society, but in times of great opportunity or great challenge, those that respond in strength and resources are the ones which will be most successful. Our national associations have limited members—25 percent support the ACA or the ICA—with the other 75 percent sitting on their hands. It’s the same with the Foundation for Chiropractic Progress and alumni support of the colleges. Especially with all the debate and discussions on healthcare going on right now, chiropractors deserve to be an important and essential part of any healthcare in our country. It is our responsibility as a profession to support efforts at the state and national level to improve access and knowledge of chiropractic care. The most successful state associations are the ones with the most active participation. 

It makes it that much more difficult for the leaders of the national organizations, the leaders of the state associations, the leaders of organizations of any kind in our profession, when they turn around and there are very few of their colleagues following them, supporting them and pushing them on. We have to be, as a profession, more active, and we have to participate in greater numbers. Once we do that, there’s nothing that we won’t be able to accomplish. 

Is there anything else you want to mention?

Yes. I recently returned from the 63rd Assembly of the World Health Organization (WHO), in Geneva. The WFC has been in official relations with WHO as a nongovernmental organization (NGO) since 1997 and has been sending  a delegation to this annual meeting since 1988. Many meetings have taken place in Geneva with government leaders from around the world that have led to many important achievements for the profession. In 2005, WHO Guidelines on Basic Training and Safety in Chiropractic were published and now are in 11 languages. This WHO endorsement has caused much new acceptance of chiropractic around the world, by governments and universities and other health professions. 

We now have the first DC on staff at WHO, Dr. Molly Robinson, and at the Assembly she was able to facilitate meetings with WHO officials on new projects and support of CCEI standards. WHO recognizes chiropractic as the leading profession worldwide in manual healthcare, and WFC administered the first ever WHO international meeting on manual healthcare in Beijing, China in November 2008. A second international meeting is being discussed for 2011.

Aside from yourself, who else represented chiropractic at the 2010 WHO meeting?

At the Assembly, the WFC delegation included college president and CCE-I president, Dr. Joe Brimhall. We had several young chiropractors with the World Congress of Chiropractic Students with us, including current chair and vice chair Erin Spindler and Stan Hom. Erin and recent graduate and former WHO intern, Dr. Dan Bronstein, met for their second time with leaders from the World Federation of Medical Students—opening lines of greater communication and understanding. Other members of our delegation were David O’Bryon, Executive Director of the Association of Chiropractic Colleges; Dr. Rand Baird, chair of the WFC Public Health committee; Dr. Ron Kirk of Life College, who is generating great interest with his Straighten Up World program; and Dr. Betsy Sue Robinson, a former SACA national chair. As an example specifically related to the United States, we were able to visit with the Surgeon General of the United States, Vice-Admiral Dr. Regina Benjamin. I was able to introduce the Surgeon General to a young chiropractor who just graduated, Lance Cohen.

He’s from our school, Cleveland Chiropractic College–Los Angeles.

Yes. Lance interned, as you know, at the Bethesda Hospital [National Naval Medical Center, Bethesda]. He and the Surgeon General were able to talk about his experience. The Surgeon General didn’t know that there has been a chiropractor at Bethesda for something like eight years now. And I was there when she remarked to Lance, “You know, that’s the future of health care in our country, when chiropractors and medical doctors work together in an interdisciplinary setting in the best interest of the patient.”

Beautiful!

We also visited with Mary Wakefield, who is the administrator of the U.S. Health Resources and Services Administration. She’s a major player in developing new health care policy and a very congenial lady. She commented to us that chiropractors were included in the community wellness and workforce sections of the new healthcare legislation. She told us that it’s all up on their website (www.hrsa.gov). So she was very aware of chiropractic. And several in our delegation were able to meet for the second consecutive year with the Secretary of Health and Human Services, Kathleen Sebelius. It’s important for her to know that chiropractors were there as part of the healthcare professions, and that we’re concerned about many issues involving healthcare, not only in our country but around the world.

We also got to meet with the president of the American Nurses Association, Rebecca Patton. We had a great conversation with her. She remarked that they have been working for a long time [since the early 1990s] with the ACA coalition on healthcare. This is PARCA, the Patient Access to Responsible Care Alliance, which is a broad coalition of many healthcare organizations.  She was very well aware of the cooperation between our professions. So chiropractic is really getting noticed. We are closer than you think to the tipping point—more of us just have to get involved and invest in our profession.

Daniel Redwood, DC, the interviewer, is a Professor at Cleveland Chiropractic College–Kansas City, and Editor-in-Chief of Health Insights Today and The Daily HIT.