With the great onrush of interest in alternative and complementary medicine (CAM) that has swept our nation and others, we have seen a concomitant elevation of supportive rhetoric and a decline in supportive science.
It is an interesting time for us, not just as a profession, but as part of a society that is increasingly charmed by and even seduced by people and what they say, paying precious little attention to their credentials, or even more importantly - to the underpinning support for their rhetoric. There is a vast interest by the public in things of a mysterious nature, in the so-called miraculous; in angels; in the occult; and in the unknown.
It is easy to think that this represents some kind of spiritual renaissance, but I am led to believe that it might well be related more to a lack of interest in the rigors of life. Put it more simply, people are looking for easy answers to difficult problems.
I wish there were a legitimate and strong interest in spiritual life and all that it entails. For those who know about the established religions, there is the awareness that spiritual development has its own set of rigors. A healthy soul is not handed to anyone on a platter. Being a paragon of virtue is not easy, and there is no angel waiting patiently in the wings to provide all wants and desires.
The issues of life and its difficulties lead inescapably to a concern about physical and mental illness, and it is in this context that much of the current rhetoric about healing is directed. In the instance of our own profession, a lot of what I read centers on the idea that vertebral subluxation is the bane of human existence, or if not that, at least humans would be better off without it. Because the spokesperson is often thought to be charismatic and makes a good pitch, there is a strong desire, and even a propensity to believe every word. It is true, that to some of the "true believers," if the listener does not believe and embrace the spoken chiropractic "truth," that the listener is somehow anti-chiropractic.
In the minds of a number of my colleagues, even this article will place me in the doghouse, as an "MD wanna-be," "chiropractoid," "medipractor," etc. It is precisely about that kind of thinking that I am writing today, and about the rhetoric of the preceding paragraph.
Those of us who claim to be holders of the doctor of chiropractic degree have an obligation that rises above that of most people, even in other professions. It is higher than that of the architect, the engineer, the teacher - even the college professor. Our obligation to the people whom we serve cannot be avoided by rhetoric about how wonderful chiropractic is, or about how we have always known the world would come around to what we have always known, or about Newtonian theory, quantum physics, or any other currently popular concepts.
Our obligation to the people whom we serve continues to be our responsibility, and it is not one we should try to avoid. On the contrary, during this time of great interest in the mystical, we should feel even more obligated to our patients so that we know they will not be inappropriately served by us.
Where is this leading? It leads, as it always has, to science as a way of "fixing our beliefs." It was Charles Peirce who wrote the following about how we determine if what we believe to be true is true. He said there are four ways of knowing or "fixing" belief (I will paraphrase):
- The method of tenacity - I know this is true because I believe it is true, and you cannot dissuade me from this knowledge.
- The method of authority - I know this is true because someone in authority said it is true.
- The a priori method - I know this is true because it makes sense; it stands to reason.
- The method of science - I know this is true because procedures to test this belief have been used by various people that are constructed in such a way that the outcome is devoid of the personal perceptions of the investigator. We call this the scientific method.
As members of the healing profession, we have an obligation to keep our promises to our patients. The promise, whether made directly or implied, is that what we do as chiropractors or chiropractic physicians will positively affect the outcome of the complaint for which patients seek our services. Some in the profession have taken the position that we are not trying to "heal or treat" anything. We are merely trying to locate and correct spinal subluxations.
The simple implication of that statement is that spinal subluxations are not good for humans; otherwise there would be no reason to try to "correct" them. If they "are not good" for people, then they must be "bad for people." They cannot be neutral, for if they are, there is no reason to treat them. By definition, then, subluxations are "bad for people," and are believed to negatively affect health.
What is the promise that comes out of any attempt to wiggle around the issue of spinal subluxation and its relationship to human health? The promise is that chiropractic physicians are going to improve some component of the patient's health through the procedure of spinal adjustment.
Where are we in our process of fixing our belief in this concept? Where are we in fulfilling our obligation to our patients? I believe that for the most part, we are at the method of tenacity; some are at the method of authority; some are at the a priori method; and when it comes to vertebral subluxation, I do not think there is any ability for us to say we have used the method of science to fix our beliefs.
Even the most recent studies (from Duke University) that looked at cervical adjusting and headaches, referred to determining the presence of vertebral subluxations by palpation of some type. Still, beyond this outcomes study, we have nothing scientific to support the idea that vertebral position or movement qualities are clearly linked to better health and the production or aggravation of disease.
Granted, we have all observed people in our practices that have regained health with our help, but even those who practice "straight chiropractic adjusting" cannot make any legitimate claims that it was the adjustment of this or that vertebra that caused healing, improvement, revivification, or any other word one might choose to apply.
My point: We should not be charmed by anyone's rhetoric. We must re-establish our interest in scientific research as a way of fixing our beliefs in what we do.
I know firsthand that there is research going on in our institutions. Here at National, we have been engaged in the legitimate business of scientific research since at least 1983, when Dr. John Triano began to investigate ergonomic issues. That has not diminished throughout the tenure of Dr. Brennan, who concentrated in some of the best biological studies related to spinal manipulation that have ever been done, to the present work by Dr. Cramer and his colleagues, which includes an animal model of vertebral fixation being done in collaboration with Palmer University.
Also, in years, we have seen the establishment by legislative fiat of the Chiropractic Consortial Center for Research at Palmer University, with 11 chiropractic institutions or programs involved in this effort.
All of this is good, but what I sense is that the profession-wide interest and impetus that got us moving in the direction of legitimate research is waning, because of society's (and our profession's) willingness to be charmed by the current rhetoric. No matter how good this all sounds, we will be held accountable in the long run. It is necessary for each of us to get back on the science bandwagon, so to speak, to be involved in it, to support its concepts, and especially to finance it.
When future generations look back upon our efforts, let it not be said that we depended upon the "authority" of a few people to decide what we believed. Rather, let us demand of them that they recognize us for the objectivity that we have brought to the practice of chiropractic through the application of science as our method of fixing our beliefs.
James Winterstein,DC
president,
National University of Health Sciences.
