The August 2026 On Purpose Politics Segment Examines Regulation, Licensure, Chiropractic Education, and the Growing Demand for Evidence
Professional regulation is usually defended in the language of public protection. Accreditation is justified through educational quality, examinations through competency, and licensing requirements through safety. Those aims are difficult to dispute in principle. The harder questions begin when particular institutions, examinations, and educational structures become embedded in the system for decades. At that point, asking whether a requirement once served a legitimate purpose is no longer enough. The more demanding question is whether there is evidence that it remains necessary now.
That tension runs throughout the August 2026 Politics segment of On Purpose, led by Dr. Matthew McCoy with the broader institutional concerns that he and Dr. Christopher Kent have examined throughout their work. McCoy moves through several developments that might initially appear unrelated, Singapore’s approach to chiropractic regulation, changes to the National Board of Chiropractic Examiners Part IV examination, Washington State’s licensing requirements, the Council on Chiropractic Education’s policies, and growing student pressure for educational reform. His argument connects them through a common concern: when private professional organizations become deeply integrated into public licensing and accreditation systems, their standards can acquire consequences far beyond the organizations that created them.
The discussion is pointed and openly critical. It is also important to distinguish McCoy’s interpretation from the underlying institutional record. Some of the central developments he discusses are independently documented. Singapore’s Ministry of Health stated on September 8, 2026 that chiropractic services are currently considered complementary and alternative treatment and are not regarded as sufficiently high risk to warrant statutory professional regulation, while noting that this position could change if the risk profile changes. CCE, meanwhile, announced in July that it would withdraw from U.S. Department of Education recognition, explaining that increasingly prescriptive federal requirements threatened its independence and imposed burdens that outweighed the benefits of recognition.
Those facts provide the setting. The August Politics discussion is concerned with what they mean.
“Sometimes the greatest professional growth begins when we stop asking how to build a bigger practice and begin asking why we entered the profession in the first place.”
Regulation and the Question That Comes Before It
Singapore offers a useful starting point because its government approached chiropractic regulation from a risk-based premise. In its parliamentary response, the Ministry of Health said that decisions about professional regulation should consider the nature and scale of practice, patient awareness, and evidence of adverse outcomes. It concluded that chiropractic is not presently considered high risk and therefore remains self-regulated through professional associations, alongside existing consumer-protection and advertising laws.
McCoy interprets that decision through a larger debate about the World Federation of Chiropractic and professional standard-setting. In the segment, he argues that international professional organizations should not be able to transform their preferred standards into government requirements merely because those standards already exist. He contrasts that with what he sees in Singapore, a government asking whether the demonstrated level of patient risk justifies statutory intervention in the first place.
That distinction deserves attention even apart from the institutional dispute surrounding it. Regulation and safety are related, but they are not synonyms. A regulatory requirement can protect the public, yet its existence does not by itself prove its effectiveness. Evidence must connect the intervention to the risk it is intended to reduce.
“What evidence shows that government control is actually necessary?”
— Dr. Matthew McCoy
This is the more consequential question raised by the Singapore discussion. If a professional organization proposes an examination, accreditation requirement, or statutory registration system as a public-protection measure, the relevant inquiry extends beyond whether the organization considers the standard desirable. What harm is being addressed? How prevalent is it? What evidence indicates that the proposed requirement reduces it? Those questions do not argue against regulation. They define the evidentiary burden regulation should be prepared to meet.
When a Licensing Requirement Changes Outside the State
The implications become more concrete in Washington State.
Washington’s Chiropractic Quality Assurance Commission has responsibility for establishing and monitoring qualifications for chiropractic licensure. Yet the August segment focuses on an inherent complication when a state incorporates an examination developed and administered by a private organization into its licensing structure. The state determines that the examination is required, while the examination provider determines much of what the examination becomes.
McCoy discusses the redesign and centralization of NBCE Part IV against that background. Washington’s official March 12 agenda confirms that Dr. Davis had participated in the NBCE Part IV Test Development Committee meeting in Greeley, Colorado, in February 2026. According to the meeting record as characterized in the On Purpose transcript, Davis subsequently expressed concerns about elements of the redesigned examination and indicated that, if the decision had been his, he would have retained the existing Part IV structure rather than moving the examination to Greeley. McCoy emphasizes the institutional consequence: Washington may decide whether to require Part IV, but it does not itself determine the examination’s content, scoring, location, fee structure, or retake policies.
The issue is therefore larger than whether one version of Part IV is preferable to another. It concerns delegation. Once a privately administered examination becomes part of a public licensing standard, substantive changes to that examination can affect applicants even when the underlying state requirement remains unchanged.
“A seat at the table did not mean authority over the design.”
From the August On Purpose Politics discussion
A profession committed to evidence should be able to examine that arrangement without assuming either that centralized testing is inherently improper or that longstanding adoption is sufficient justification for its continuation. The defensible standard is more exacting: identify the competency being measured, demonstrate that the assessment measures it reliably, and show why that competency is sufficiently important to justify making the examination a condition of practice.
The Students Are Asking a Different Kind of Question
The discussion becomes more consequential when it turns to chiropractic education.
According to McCoy, student representatives have challenged CCE and other institutions over Part IV, Policy 56, educational cost, program length, alternative accreditation, and the relationship between curricular requirements and demonstrated competency. He portrays their intervention not simply as resistance to existing requirements, but as a request for evidence supporting them.
That distinction matters. A curriculum may contain material that is individually defensible while still producing unnecessary duplication when considered as a whole. Requirements accumulate through accreditation standards, licensing statutes, institutional traditions, examination expectations, and previous generations’ assumptions about professional identity. No single organization needs to mandate “redundancy” for redundancy to emerge.
The transcript places particular emphasis on the historical reliance on prescribed educational hours. McCoy argues that if chiropractic education is moving toward competency-based outcomes rather than treating seat time as a proxy for competence, the same evidentiary principle should be applied consistently. If thousands of required hours need justification, then the requirements contained within those hours should also withstand scrutiny.
“If Part Four is necessary, demonstrate the indispensable competency it measures.”
— Dr. Matthew McCoy
This may be the strongest intellectual thread in the August segment because it does not require agreement with McCoy’s broader institutional critique. Competency-based education changes the burden of proof. Tradition can explain why a requirement exists, but it cannot establish that the requirement produces an outcome worth its cost.
CCE, Independence, and Accountability
CCE’s changing relationship with federal recognition adds another layer.
In July 2026, CCE announced its decision to withdraw from U.S. Department of Education recognition. Its own explanation emphasizes independence, arguing that increasingly prescriptive recognition requirements could interfere with peer review and CCE’s ability to establish accreditation standards responsive to chiropractic education. CCE also states that its withdrawal does not itself alter the accreditation status of its programs and that institutional accreditation, rather than CCE’s programmatic accreditation, is the basis for participation in Title IV federal student aid.
McCoy reads the development more critically. His concern is not merely that CCE sought independence from federal recognition, but that the profession should examine how claims of independence interact with policies that make schools dependent upon other private systems. Policy 56 becomes central to that argument because, as described in the segment, NBCE examination performance can function within CCE’s accreditation framework even though CCE does not control the examination itself.
The competing perspectives should not be collapsed. CCE describes its withdrawal in terms of preserving appropriate accreditation independence and reducing regulatory burden. McCoy argues that independence must be examined consistently, particularly when the accreditor’s own policies rely upon standards or examinations controlled elsewhere. The disagreement is therefore not simply over whether CCE is “for” or “against” reform. It concerns who controls reform, what evidence supports the remaining requirements, and how much institutional dependence is appropriate within the profession’s educational infrastructure.
Reform Inside the System, or Reform of the System?
CCE is already revising its standards. In 2026 it publicly solicited comments on proposed revisions to its accreditation standards, providing a formal period for constituent feedback. The August Politics segment acknowledges that educational reform is occurring, including movement toward competency-based approaches. McCoy’s objection is narrower and more structural: reform permitted by an incumbent institution is not necessarily the same thing as reconsidering whether that institution should retain its existing position within the regulatory architecture.
The transcript describes a historical pattern in which state statutes, accreditation standards, national examinations, and institutional requirements became increasingly interconnected. McCoy argues that this has created a system in which changing one component can be difficult because other components depend upon it. He therefore frames the present moment as an opportunity to examine not only individual rules, but the relationships among the organizations that administer them.
“The real test is not whether the gatekeeper is willing to change its own rules, it is whether chiropractic education can change without needing the gatekeeper’s permission.”
Dr. Matthew McCoy
That is a provocative formulation, but beneath it lies a legitimate governance problem. Institutions inevitably develop interests in preserving systems they administer. That does not establish misconduct, nor does it invalidate their standards. It does mean that accountability mechanisms matter, especially where private organizations exercise substantial influence over education and entry into a licensed profession.
Evidence Has to Work in Both Directions
The August Politics segment ultimately turns the profession’s familiar language of evidence back upon its institutions.
Chiropractic has spent years debating evidence in clinical practice. McCoy’s argument is that the same discipline should govern educational and regulatory policy. If an examination is indispensable, its value should be demonstrable. If a particular curricular requirement protects competency, its contribution should be measurable. If accreditation requirements increase the cost or duration of education, the resulting benefit should be identifiable rather than presumed.
This does not require abandoning standards. Quite the opposite. Standards become more credible when the institutions responsible for them are willing to explain what each requirement accomplishes, what evidence supports it, and whether less burdensome alternatives could produce the same or better outcomes.
Students occupy an unusual position in this debate because they experience the accumulated cost of these decisions most directly. They encounter the curriculum as it presently exists, pay the tuition attached to it, sit for the required examinations, and enter professional life under the resulting financial and regulatory constraints. In McCoy’s account, their demand is increasingly straightforward: do not merely explain that a requirement exists. Demonstrate why it should.
That demand should be uncomfortable only where the evidence is weak.
The August 2026 Politics segment does not resolve the disputes surrounding the WFC, NBCE, CCE, state licensing boards, or the future structure of chiropractic education. It does something more useful for an editorial discussion. It identifies the question against which competing proposals can be examined: What evidence demonstrates that the requirement produces the outcome used to justify it?
For a profession navigating substantial educational and regulatory change, that question is neither anti-regulation nor anti-institution. It is a demand that institutional authority and professional standards be subjected to the same intellectual discipline expected elsewhere in healthcare.
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About On Purpose
The On Purpose Podcast is hosted by Christopher Kent DC, JD, MBA, ACP and Matthew McCoy DC, MPH. Since the early 1990s, On Purpose has been the spearhead of the Chiropractic Freedom Movement. It began as mailed cassette tapes, evolved into CDs, then online audio, and now lives on Substack with full-length video segments in Science, Philosophy, and Politics.
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