Chiropractic Philosophy and Science: Not Necessarily Strange Bedfellows

I am often invited to speak to chiropractic groups on a variety of topics, but one recent invitation was especially challenging and thought- provoking. The World Federation of Chiropractic (WFC) asked if I could address its May 2001 meeting in Paris, in conjunction with the European Chiropractic Union, on the relationship of the philosophy of chiropractic to the science of chiropractic, and the clinical application of both.

As you know, there has been an uncomfortable dialogue between "philosophers" and "scientists" in the chiropractic profession. I believe this tension is artificial and is maintained for political and power purposes. I have seen "philosophers" boycott scientific discussions, and I have witnessed a planned public exodus of "scientists" from public meetings, when the subject or discipline of philosophy was introduced.

I think I have a unique perspective from Palmer College. Here, the profession finds the best of both worlds: philosophy and research. In philosophy, our students have the opportunity to learn from the profession's best thinkers and writers, including my contemporaries: Drs. Fred Barge; Victor Strang; Vern Hagen; quantum physicist Bruce Lipton; and David Koch. These current faculty members continue to build on the philosophical foundation set by chiropractic's philosophical greats like Drs. R.W. Stephenson, Galen Price and Virgil Strang. Then we move these traditional principles into contemporary philosophical dialogues that are reshaping today's health care environment. Palmer students get a solid grounding in the philosophy of chiropractic, and through our inclusion of visiting and adjunct faculty, they are exposed to many different facets of this profession's unique philosophy. In the area of chiropractic philosophy, our team its product are second to none.

The same could be said of our team and our product in chiropractic research. The Palmer Center for Chiropractic Research is already the largest chiropractic research facility in the world, and soon it will be bigger and better. Last fall, Palmer was awarded a facilities construction grant for $1.3 million from the National Center for Research Resources, a division of the U.S. National Institutes of Health (NIH). An estimated $2 million will be matched by the Palmer Chiropractic University System, for a projected total of up to $3.3 million for renovation and expansion of the existing Palmer Center for Chiropractic Research (PCCR) facility in Davenport, Iowa. This is the first time the NIH has directly funded a "brick-and-mortar" project for research at a chiropractic institution.

The PCCR is the headquarters for the federally funded Consortial Center for Chiropractic Research (CCCR). Together, the PCCR and the CCCR receive three to five million dollars in federal funds each year. Add to this $1.3 million from Palmer's budget, and you can see our commitment to research. The stated goal of the Palmer Chiropractic University System Board of Trustees is to increase that funding to $50 million a year. This will ensure that the PCCR, as the premiere chiropractic research facility, will be able to conduct expensive, time-consuming basic science research necessary for a full-fledged subluxation-centered research program. We've already taken the first steps in creating this program at Palmer with our facilities upgrade, bringing research experts in neuroscience and spinal biomechanics on board.

As part of the contract with federal agencies such as the Health Resources and Services Administration and the National Center for Complementary and Alternative Medicine, which support the consortial center, we coordinate an annual chiropractic research conference. The Research Agenda Conference, or RAC, is helping to set the worldwide agenda in chiropractic research and researcher training.

So at Palmer, we literally have the best of both worlds in philosophy and science, and these worlds, for the most part, coexist with mutual respect. As for the rift between these two aspects of chiropractic, I propose a solution we have implemented, an environment where a possible solution can be found, based on the belief that patients and chiropractors will be better served with quality care and clinical knowledge, respectively.

We each have our own epistemology, or faith, if you will. The philosopher is interested in the rational, logical deliberation of ideas and possibilities, the scientist in the tangible quantification of information. Most clinicians and patients experience a reality devoid of the aforementioned dialogues. Their focus: "It worked for me," or "It worked for my patient."

In short, people are living their lives, falling in love, having children, etc., yet science tells them these experiences shouldn't be taken too seriously until they study and understand reproductive anatomy/physiology. On the other hand, philosophy becomes so theoretical as to render its pragmatic application irrelevant. If the philosophers and scientists can reach common ground on the goal of chiropractic, helping people live healthier lives, while at the same time recognizing that each has a place in the time-honored triune of chiropractic philosophy, science and art, then the value of both will be enhanced.

This ideal may be utopian, considering the historical baggage that comes with the "philosophy vs. science" debate, one that has caused philosophy to be wary of science, and vice-versa. There are several reasons for this conflict.

First, the science of chiropractic has been used as a weapon against the practice of chiropractic. The insurance industry has used science as a weapon to limit chiropractic practice only to what has been scientifically (evidence-based) proven and validated. It is unrealistic to say chiropractic must meet a standard, when government dollars have only been flowing for less than 10 years. And the dollars are fractional compared to those granted to medicine. Give us 10 or 20 billion dollars per year and then hold us accountable. There is a big difference, however, between saying, "chiropractic has been effective for patients and has had positive results for 106 years, but we just haven't been able to prove it scientifically yet," and saying that if we haven't validated x, y, or z condition, it is not appropriate to practice, teach, legislate or reimburse for this care.

Another reason for the rift between philosophy and science is that both aspects of chiropractic have been plagued by dogma over the years. Chiropractic philosophers have traditionally refused to open up chiropractic philosophy for observation and critique. That is dogma. Science, too, suffers from this. Scientists only explore what they choose to explore and validate accepted beliefs. When they will not explore beliefs and questions beyond a prescribed barrier, such as disease and treatment, that is dogma, too.

An additional cause for distrust between science and philosophy is the "politics and religion" debate. Science points a finger at the unknown and calls it "quasi-religious." But for many, science is the new religion. It sees itself as superior - the only epistemology and the dispenser of truth. It does not tolerate other paths, and refuses to have its processes challenged.

Finally, the rift between science and philosophy has traditionally been widened because science asks for questions to explore with the expectation that scientific discovery will answer these questions. But the hard questions in chiropractic have never been answered by science. These include: What is health vs. disease treatment? What is subluxation? How does chiropractic affect the quality of life, function and adaptation? Up to now, chiropractic science has disregarded these questions and has performed mostly evidence-based research in condition-based care. This drives philosophers to minimize scientific efforts.

What can we do? We must create a new partnership. Philosophers are great at asking questions, and scientists need questions to study and validate. The future of the chiropractic profession will depend on how well philosophy and science can put the dogma and politics behind them in order to work together to ask the questions and scientifically explore the core principles of the chiropractic profession. Philosophy and science need each other, and the students of these two schools of thought must work together so that this profession can take its rightful place at the forefront of the evolving health care arena.