A recent article in Dynamic Chiropractic (June 26, 2000, NE edition) titled "The Third Paradigm" by Reginald Gold, DC, PhC, discussed three different paradigms of chiropractic thinking within the chiropractic profession. His theories were insightful and suggested some important ramifications for the future of the chiropractic profession.
The first type of practice I would like to discuss (Gold's second paradigm) consists of those who utilize chiropractic as a therapeutic modality; that is, for the treatment of some diseases, primarily musculoskeletal conditions. This approach represents the vast majority of chiropractors around the world. The overwhelming advantage of practicing in this model is its current acceptance by the public, the profession, and today's health care paradigm. When most people think of chiropractic, they think of - bad backs or stiff necks.
These practitioners rely on scientific research and studies that suggest that chiropractic has therapeutic efficacy. They often quote studies that have shown that chiropractic care reduces time missed from work or that it is less expensive than traditional medical care. This is of particular interest to insurance companies, since they were designed precisely to pay for this type of care.
Generally speaking, these types of cases require only temporary and occasional care. While insurance companies have begun to reimburse for some wellness care (e.g., smoking cessation programs or limited memberships at health clubs), actuarial studies indicate that most people will not utilize these services. Insurance companies, after all, are in the business of making money.
One of the major disadvantages of this type of practice, as Dr. Gold clearly discusses, is the absolute necessity of diagnosis. It only makes sense that you could not offer treatment for a condition unless you have made a determination as to what condition is present. Specifically, to state or imply (although there is no difference between the two from a legal standpoint) that chiropractic would be beneficial to a person suffering from backache is not just to make the determination that the person actually has a problem (i.e., diagnosis), but that it is caused by subluxation (i.e., differential diagnosis, ruling out the possibility that it is caused by anything else).
Another important disadvantage to practicing in this paradigm is that inevitably, we will have too many chiropractors for the number of people needing care. While it may be true that some 80 percent of the American public suffer from back pain at some point in their lives, it is also true that most of those cases are temporary inconveniences that resolve themselves with or without chiropractic care. This has manifested itself in the actions of some of our chiropractic leaders and decisionmakers as they try to limit the number of people who may enter chiropractic schools or pass boards, present ever-increasing obstacles to licensure in certain states, and oppose the opening of new schools.
These disadvantages, coupled with the fact that this type of care-therapeutic manipulation-is a duplication of services, have resulted in unfortunate ramifications for the future of the profession. It is becoming increasingly common to have other health-care practitioners, including medical doctors and physical therapists, perform manipulation. The development of "integrative medicine" (a term coined to describe the MD who uses alternative approaches) shows the medical profession's increasing acceptance of alternative therapeutic approaches. With the increasing number of people utilizing alternative health care, the medical world would be remiss to not begin to seriously consider and incorporate, whenever possible, these approaches in their repertoire (if only from a financial standpoint).
Realistically, if the objective of medicine is to treat or prevent disease, it would make sense that they would utilize whatever techniques might best fulfill that objective and hence support "integrative medical practitioners." Ironically, if research does prove chiropractic to be therapeutically efficacious, health care practitioners would be negligent to not adopt this approach (and many to date have, albeit it is often times a crude impersonation of a gentle, specific adjustment). The obvious and natural outcome then for this type of practice is absorption.
The second type (Dr. Gold's first paradigm) consists of those who hold to the traditional Palmer view (as in D.D. and B.J.) that chiropractic cures all disease. While many would suggest that the number of people who practice in this manner are rare, including Dr. Gold, they are greater in number than even those who would admit to practicing this way would suggest. While most chiropractors would not purport that their objective is to cure all disease, what they say and do clearly indicates that this is in fact how they are practicing. When chiropractors use phrases like "Chiropractic gets sick people well" or "You are a chiropractic case," they are necessarily implying that chiropractic can help the condition for which patients present.
Admittedly, chiropractic can help everyone; that is, people are better off without interference to the nervous system. However, when a mother takes her child with a fever or an ear infection to a chiropractor and hears "Chiropractic can help," she thinks chiropractic is a treatment for her child's condition, not that it is beneficial for every individual.
There are great advantages to this type of practice, not the least of which is that it can be financially rewarding, since this marketing includes a wide variety of conditions in a broad cross-section of the public. Some of the largest and most successful chiropractic practices in the world today practice this approach. It can also be very gratifying to assist in healing the suffering of mankind, possibly saving some people from unnecessary drugs and surgery. Unfortunately it is not completely honest. Chiropractic does not always "work" in this manner.
Unfortunately, everyone under chiropractic care does not get well from his or her symptoms. This can result in serious legal and public relations complications. If you have led patients to believe (by word or implication) that your care will effectively treat their conditions, you can be held liable for delaying "proper medical care" in the event that the condition does not improve or worsens, or if there is another condition you have not identified.
The unfortunate ramification for the profession utilizing this type of thinking is eventual oblivion. Because it is neither therapeutic (by admission) nor nontherapeutic (by practice), it will result inevitably in confusion. If it is therapeutic in nature, why would someone continue under care after they got well? If it is not therapeutic in nature why would insurance bother to pay for it? If it is sometimes one and sometimes the other, how is a person seeking care to know which is which? And if they can't know, why would they go?
Many chiropractors have stretched the truth as to what we know chiropractic can do for any individual. Yes, everyone is better off without interference in his or her nerve system, but we can no more say that chiropractic cures asthma because some asthmatics have noted improvements in their condition while under chiropractic care than we can say that chiropractic cures deafness because of the Harvey Lillard case. It simply is not true.
Some people with asthma will not improve with chiropractic, and to suggest that they will when they will not is quackery. In the realm of therapeutics, we must play by the medical profession's rules. One needs look no further than the FTC's recent allegations against the educational materials distributed by Koren Publications to see the result of this type of chiropractic thinking. You cannot be all things to all people.
The third type (Dr. Gold's third paradigm) consists of those who locate, analyze and correct vertebral subluxations, because they are a detriment to the fullest expression of life in every man, woman, and child. The objective for this type of practitioner is nontherapeutic in all cases. The overwhelming disadvantage of this type of practice is that, being a small percentage of the chiropractic profession, it is often misunderstood, under-represented and often wrongly presented. Still, the advantages far outweigh the disadvantages.
Missed diagnosis or incorrect diagnosis is never a concern, since it is always made clear to the person seeking care that it is not the objective of the chiropractor to diagnose or to treat any condition. This makes this type of practice the safest. The need for everyone to have their spines checked on an ongoing basis from the time they are born until the time they die suggests that we do not have nearly enough chiropractors.
In fact, this type of practice, which is separate and distinct from any other health care profession, is the only one which guarantees not only a future for the chiropractic profession, but ensures a brighter future for all mankind. It alone cares for all people, whether they have a condition or not, and whether they are aware of it or not.
All people are better off without interference to the nerve system. It just makes sense. It allows for the fullest expression of life in all people, and is not dependent on dwindling third-party pay. It's just that simple.
Judy Nutz Campanale,DC
Levittown, Pennsylvania
Editor's Note: Dr. Campanale is president of the Federation of Straight Chiropractors and Organizations. She is a graduate of Carnegie-Mellon University and the Pennsylvania College of Straight Chiropractic.
When I graduated from chiropractic college in 1981 and started practice, I heard it all, and very little was positive. “You are a quack; you do not know what a subluxation is; you couldn’t get into a real health care program, so you chose the one that is slightly above a mail-order degree; you have no proof that chiropractic works; Are you really licensed?”, and so much more.
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