When I started in private practice with Warren Lee,DC, in 1964, I took much of his advice to heart. Among his opinions was a strong distaste (to put it mildly) for the efforts of John Nugent,DC, long-time director of education (1941-1961) for the National Chiropractic Association (NCA), the forerunner of the ACA. Nugent had been fired by this time for speaking his mind to his employers, but the anger he generated among many chiropractors in the field would linger for decades. B.J. Palmer referred to him as the "Antichrist of chiropractic."1
Among Nugent's dastardly deeds were: the closing or consolidation of many small, for-profit schools to form larger, nonprofit, professionally-controlled institutions; the creation in 1947 of the NCA Council on Education (destined to become today's federally-recognized Council on Chiropractic Education; and public discussion of the foibles of chiropractic education. This man, as Dr. Lee pointed out, had the gall to air the dirty laundry in public!
I was reminded recently of the antipathy I carried around for 20 years toward this man I never met. The recent Research Agenda Conference VII (RAC) in New Orleans, held in conjunction with the annual meeting of the Association of Chiropractic Colleges, offered a cornucopia of posters and presentations on clinical science, basic research, professional issues and educational innovations. One couldn't help but be in awe at how this profession has progressed and matured over the years despite the many obstacles, and sometimes in spite of ourselves. I rather imagine that Drs. Lee and Nugent would be impressed.
What sparked my memory of Nugent was a poster presented by David Sikorski,DC, and his co-investigators at the Southern California University of Health Sciences (SCUHS, formerly LACC) and CMCC: "The Unsubstantiated Website Claims of Chiropractic Colleges in Canada and the United States." It was a follow-up to a survey of patient brochures distributed by various state and national professional associations.2 Here were chiropractors offering criticism of our own profession. They contended that many of the assertions made for the value of the chiropractic art are not validated by the research literature. The poster presentation identified various problematic statements, the website pages from which the assertions were extracted, and explained why each statement was inappropriate. I had to wince: Of the 16 college websites they examined, half included one or more unsubstantiated claims (including, I regret, my alma mater). Dr. Sikorski's employer, SCUHS, was also included.
Once upon a time my knee-jerk reaction would have been, "Fire that guy!" But I'd like to think that I've matured, as has the profession. As I prepare for an updated version of an earlier paper on the status of my company, Activator Methods (AM),3 I'm reminded of the heat it and I took for "fessing-up" to the limits of our knowledge. Our own words, demarcating the boundaries of evidence in AM, were thrown back in our faces, and it was painful. Yet, through it all, I believe we have benefited by taking stock of ourselves and planning accordingly.
Dr. Nugent, I suspect, would approve. He faced the same predicament during World War II when the AMA introduced his published criticisms of chiropractic education during U.S. House Judiciary subcommittee hearings. It was an effort to block congressional authorization of chiropractic services for federal employees. Nugent responded:
"No profession, particularly medicine, which has needed and received so much help from outside sources in the form of educational direction, philanthropy and state-aid can afford to forget its lowly educational origins, nor can it afford to criticize those who by honest self-criticism are making a painstaking effort to correct their deficiencies."4
Self-criticism, suggested the director of education, is a "good sign," an indicator that an individual or group is committed to self-improvement. Yet, just as surely, it comes with risks. Sikorski and co-investigators' work caught the attention of the media (
Time magazine's website), and a highly critical commentary about the profession was posted on line. We should have learned long ago that what we
say (and
write) can and will be used against us.
But in this case, we may wish to pause and ask ourselves, "Who aired the dirty laundry"? Yes, the chiropractic researchers surveyed our patient brochures and website marketing, and identified scientifically unjustified claims for the chiropractic healing art - claims which may be true but have not yet been validated. Should we instead look askance at ourselves for speaking and writing beyond the available database? Are we so fragile as a profession that we must pump ourselves up by offering our hypotheses (clinical suspicions) as truth? Or might we wish as a member of the wider health care professions to let the public know how we think we can help, but frankly acknowledge the scientific limits of our knowledge?
The internet revolution, now more than a decade old, has opened up marvelous channels of communication. Unlike the print and broadcast media, the web offers inexpensive avenues for education and marketing with a potentially unlimited audience. It can be a boon or a curse to chiropractors, depending upon how we choose to use it. Perhaps now is a good time for all of us to reflect upon what sorts of messages we wish to convey to the world.
At AM, our website is undergoing an overhaul. We have every intention of letting the public know of the potentially broad value of chiropractic health care, but we wish to do so in a manner that reflects well upon the science and the art. For us, it's a matter of philosophy (i.e., ethics). We have stumbled in the past, and it may happen again, but the intent is to provide the consumer, our patients and participating doctors, with the most current and factual information about our services.
In many respects, the saga of chiropractic is a tale of bootstrapping. We may justly take pride in the many ways we have grown and developed as an independent healing art. Until recently, our maturation took place by our own hands, with practically no assistance from government and private philanthropy. Now, as we look ahead at further legitimization, and integration with the wider health care enterprise, we must try to better see ourselves as others do, and communicate accordingly. There are warts and wonders in chiropractic, and it's up to all of us to identify them, self-criticize and plan accordingly. If history is any guide, the benefits of self-criticism far outweigh the risks.
References
- Gibbons RW. Chiropractic's Abraham Flexner: the lonely journey of John Nugent, 1935-1963. Chiropractic History 1985;5:44-51.
- Grod J, Sikorski D, Keating JC. The unsubstantiated claims of the largest state, provincial and national chiropractic associations and research agencies. Journal of Manipulative & Physiological Therapeutics 2001(Oct);24(8): 514-9.
- Osterbauer PJ, Fuhr AW. The current status of Activator Methods Chiropractic Technique, theory and training. Chiropractic Technique 1990(Nov);2(4):168-75.
- Congressional hearings on Tolan bill: rebuttal of Dr. John J. Nugent, NCA Director of Education, to testimony of medical witnesses. National Chiropractic Journal 1944 (Jan);14(1): 17-19,48
Arlan Fuhr,DC
Phoenix, Arizona awfuhr@aol.com
