News from Overseas
by Professor Andries Kleynhans

Introduction
Chiropractic is quite well known and widely practiced in Japan by an undetermined number of practitioners, estimated to be 10-15,000 or more. Many have completed only a 6-month to 2- year part-time program. A small number have done at least a three-year full-time course such as the course taught at the Kokusai Chiropractic College in Osaka. More recently, it has been possible to do courses at RMIT Japan. There is no statutory or professional regulation in Japan with some 20 associations providing very minimal professional control over their members.

Legal Position of Chiropractic
The American GHQ prohibited all forms of non-allopathic medicine during the post-WW II occupation of Japan nearly 60 years ago. Shortly thereafter, all complementary medicine disciplines such as Acupuncture and Bonesetting were restored to legislative status. This did not include Chiropractic. However, its practice has been condoned but only by virtue of the terms of the Japanese Constitution, which guarantees the freedom to choose an occupation; and by a Supreme Court ruling, which implies that nothing harmless should be the subject of prosecution. However, this has been without any rules, regulations or legislation to date (Nakagaki 2004).

Health care Professions in Japan
Japan has regulated and unregulated health care professions as follows:

1. Regulated health professions
   These fall into one of three groups:
   1. The medical and dentistry professions.
   2. Paramedical professions (in strict translation “medicine-related practice”). These must act on medical direction/referral and include for example, midwives, nurses, occupational and physical therapists and radiology technologists.
   3. Other regulated healing methods (in strict translation “quasi-medical practice”). These comprise four professional groups from the broad field of traditional Japanese healing methods (Ryoujitsu - pronounced ‘row-jit-sue’) that have obtained recognition and licensure during the past century and are:
      
      • Acupuncture.
      • Anma (Japanese massage)/shiatsu therapy.
      • Bonesetting (including judo repositioning and also known as Judo Bonesetting).
      • Moxibustion therapy.

   The socialized government health care system pays for services by all the above categories of professionals (Chapman-Smith 2003).

2. Unregulated practitioners
   Chiropractic practice is unrecognized by law but is legal pursuant to a 1960 Supreme Court decision affirming the Japanese constitutional right to practise traditional and other healing methods that are not hazardous to health. The Supreme Court decision involved a lawsuit by a Ryoujitsu therapist without any of the four licences mentioned above and who was using electrotherapy. It cleared the way for anyone, regardless of training, to be able to practise natural methods of healing that were unlicensed - including manual therapies and herbal medicine. It has become increasingly popular for manual therapists and their courses to use the unrestricted name of chiropractic (Chapman-Smith 2003).

Chiropractic Education
Pitifully, there is only one full international level program, at RMIT-Japan, which so far produced about 200 graduates awarded with double Bachelor degrees. The CSC (Chiropractic Standardization Course), a three-year Bachelor degree program, offered by RMIT-Japan produced about 200 graduates over 6 or 7 years. The number of graduates combining both courses is still statistically insignificant by any measure to contact and start discussion with Japanese Government (Chapman-Smith 2003).

This Chiropractic Standardization Course (CSC), was the brainchild of Professor Andries Kleynhans, in response to a need to upgrade existing practitioners who have significant practice exposure but limited underpinning in the chiropractic and diagnostic sciences. It was hoped that the introduction of the CSC would attract one or two thousand persons involved with chiropractic practice and to “standardise” them at a safe level where they would understand and manage risk factors in practice and be competent in basic musculoskeletal chiropractic practice. Once a significant number of persons had completed standardisation education, the profession would have a critical mass of practitioners and could then ask the government to introduce chiropractic legislation at two levels - the standardisation level which corresponds to the three year level of education undertaken by other registered professionals such as the Judo-Bonesetters, Acupuncturists, etc., and a higher level equivalent to the first professional degree level in other parts of the world (i.e. the DC in North America and Masters or double bachelor in Australia).

Because of political antipathy amongst different groups of practitioners and the economic downturn in the region, enrolments have been very low and it will take some time before a large enough group have reached a three year level or above to provide the “critical mass” necessary to facilitate introduction of statutory regulation.

CSC courses are currently provided by Cleveland Chiropractic College International, in conjunction with Kleynhans Education International and Kokusai Chiropractic College; Canadian Memorial Chiropractic College in conjunction with Nichibei Chiropractic College and Dr. Brian Budgell; the RMIT Chiropractic Unit - Japan; and by Murdoch University in conjunction with the Kansai Chiropractic College. It is understood that Macquarie University is involved in a program with the Toyo Sentai group.

It is regrettable that there is little overt standardisation amongst the Chiropractic standardisation courses - a prerequisite to the orderly future development of chiropractic.