"... heavy words and sweeping generalizations."
In "Why Hold a 'Belief' in the 33 Chiropractic Principles?" (Karen Shields, DC, Sept. 6, 1999, or at www.chiroweb.com/archives/17/19/19.html ) the author laments against "principled chiropractors". She asserts that they hold views and beliefs that are against scientific thinking and possibly even antithetical to a chiropractor's religious beliefs. Dr. Shields further suggests that chiropractors who accept vitalistic components of chiropractic history and early philosophy, specifically Stephenson's 33 chiropractic principles, do so out of a "childlike desire for simplistic answers."
Apparently central to her concerns, Dr. Shields wonders why one would have "a belief or faith" in something that is "not proven." She seems to feel that chiropractors who embrace with "uncritical belief" a traditional vitalistic chiropractic perspective "assume a kind of moral superiority" as a "universal priest-healer" over the rest of the chiropractic profession.
These are heavy words and sweeping generalizations. Yet in her argument I found no specific examples to support her premise. Laden with opinion rather than supportive facts, the reader of her commentary might easily reach the conclusion that she categorically rejects the vitalism of chiropractic philosophy, perhaps in favor of a more mechanistic or "scientific" approach. If that is an accurate interpretation of her argument, the author certainly has a right to hold her opinion. But her premise is hardly a valid prima facie exercise in logic. Before Dr. Shields undertakes to redefine the profession, a more critical examination of the facts is needed.
Dr. Shields suggests that all chiropractors who accept a vitalistic model as a part of a larger paradigm are cultist in belief and stunted intellectually. On the other hand, her argument seems to suggest that chiropractors are either vitalistic or mechanistic de facto, without any room for overlap in practice or exchange in thought. This dichotomy is in fact the very elitist mentality which she criticizes so strongly in her commentary.
According to Dr. Scott Haldeman in Principles and Practice of Chiropractic, Stephenson summarized the theories of D.D. and B.J. Palmer, including concepts such as innate intelligence, cycles, and the meric system in his 33 principles, published in 1927. Another vitalist, Harper, proposed six summarized principles of D.D. Palmer's theories.1
According to Haldeman, "The philosophy of D.D. Palmer included the two related elements of vitalism and science. Vitalists did not depart from chiropractic philosophy; they continued, essentially unchanged, the basic doctrine of the vitalism/science blend established by D.D. Palmer. B.J. Palmer and Harper both established research institutes and called for scientific research."2
Concurrent with and developing from the vitalistic perspective, the mechanistic approach advanced knowledge in dynamic motion, motion palpation and human biomechanics. Notable mechanists included Carver, Homewood, Janse, Illi, Gillet, and Watkins.3
Haldeman notes: "The differences between proponents of either philosophical focus were differences of emphasis, not kind, and the divergence of opinion has never been very substantial. Vitalists advocated scientific research, and those in the science pathway accepted in general the metaphysical concepts elucidated by Palmer."4
Clearly, in the early development of chiropractic thinking, two different paradigms developed, but each had strong ties to the other, with differences in conceptual emphasis rather than in clinical practice. Vitalists would emphasize a doctrine that the functions of a living organism are due to a vital principle distinct from physicochemical forces; mechanists would focus on a more anatomically-based model.
But both paradigms ensured the survival of the infant chiropractic profession born into a hostile climate dominated by allopathic medicine. Haldeman states: "It is probably true, however, that without a strong philosophical basis, chiropractic would never have become a viable form of health care."5
In 1999, can we really say with critical certainty that some of the seminal works in early chiropractic development are without any merit, even as foundations for the later evolution of chiropractic principle and practice?
In 1914, D.D. Palmer wrote: "Philosophy, special or general, is not the foundation upon which I built the Science of Chiropractic. Its science is based on tone. Tone is the standard from which we note the variations of structure, temperature, tonicity, elasticity, renitency, and tension. It is the standard of health; any deviation therefrom is disease. Tone is the Basic Principle.6"
A century later, Karel Lewit, MD, DSc., concurred in his work on Manipulative Therapy in Rehabilitation of the Locomotor System: "After more than 50 years in this field, it is now clear to me that functional restoration of the motor system ultimately comes down to tone; that is tone of the tissues." So much for old ideas losing plausibility in the 21st century.7
The July 1998 issue of the Chiropractic Report stated: "There is an unprecedented amount of new research and knowledge now emerging in most areas of human experience, including all the health sciences." In chiropractic, this expanding base of information has been the product of the evolution of chiropractic thought, including philosophy, prompting the subsequent development of many new techniques over the decades, each with an attendant focus on neurological, muscular, skeletal, or energetic components. As the Chiropractic Report noted: "Learning from and incorporating the best of others is what the founders of chiropractic did."8
Philosophy, therefore, continues to serve as a catalyst for the natural evolution of clinical theory and practice as old ideas are challenged and new ideas emerge from new perspectives of existing knowledge sources.
The founders of the chiropractic profession, no matter how controversial in philosophy, popular in exposure, or unsung in the quiet work of their private practices all contributed to the survival of the chiropractic profession through a fierce belief in a concept larger than themselves or their techniques. Peterson and Wiese in Chiropractic: An Illustrated History state: "The first several decades of the chiropractic story were a period of struggle and perseverance in the face of tremendous odds. The early pioneers built a profession from scratch, despite the enormous barriers erected by established health care interests. The dogged determination of the early chiropractors and their success in defending and propagating the profession may be attributed to many factors, but perhaps chief among these was the raw courage of their conviction that chiropractic had something very valuable to offer society. It was an age of wonderment, and if those early pioneers were guilty of naivete in scientific matters, this was balanced by their genuine concern for their patients and their passion to explore the limits of the new theories and methods."9
Today, the vitalistic and mechanistic concepts are summarized quite appropriately in an expression of evidence-based practice guidelines in the first position paper of the Association of Chiropractic Colleges. The paper stated:
"Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation. A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.
"A subluxation is evaluated, diagnosed and managed through the use of chiropractic procedures based upon the best available rational and empirical evidence."10
If these concepts, born and developed from a century of chiropractic thought and practice, provide a significant basis for the practice of "principled chiropractic," then I would be proud to be labeled a principled chiropractor.
How ironic that today when may chiropractors are embarrassed to discuss concepts smacking of vitalism, speakers such as Deepak Chopra, Andrew Weil, and Gary Null talk about that very same vitalism as the "newly discovered" alternative to allopathic medicine, using words like innate intelligence and life force. They are hailed as revolutionary thinkers and messianic healers.
Dr. Shields states in her opening sentence that chiropractic philosophy is not philosophy in the classical sense. But the survival and flourishment of chiropractic, and the development of many chiropractic techniques over the past 10 decades, would indicate that chiropractic epistemology has indeed been progressive in a relatively short span of historical time. Perhaps proof and truth are subjective concepts. When the British Medical Journal published an article stating that only 15 percent of any medical intervention has any scientific validity to support it, and that only one percent of all articles in medical journals are scientifically valid,11 did society discard 85 percent of medical practice, theory and philosophy? Whey then must we seek to create a schism of so deeply seminal concepts that are a proud part of our professional history and the driving force behind much of our professional evolution? I would rather think that there is room for all of us to develop intellectually and clinically, with perhaps a greater economy of tolerance for diverse perspectives exercised within our own profession.
Gerald Anzalone, DC
Private Practice
Peekskill, New York
References
1-5. Haldeman S. Principles and Practice of Chiropractic. Second edition. Appleton and Lange: 1992.
6-8. Chiropractic Report, July 1998, vol. 12, no. 4.
9. Peterson D, Weise G. Chiropractic: An Illustrated History.
10. Vertebral subluxation in chiropractic practice. Council on Chiropractic Practice,Clinical Practice Guideline, No. 1.
11. Rosner A. Unmasking an exposé of chiropractic: an error-ridden and misguided missive. Dynamic Chiropractic, June 14, 1999, vol. 17, no. 13, p. 33.
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