We Get Letters & E-Mail

Raising the Bar for Chiropractic Education

Dear Editor:

I have read and listened to the endless arguments both pro and con as to the merits of raising the admission standards to chiropractic college to include a baccalaureate degree. While I do not believe an undergraduate degree is a prerequisite to individual success, I do feel that it would be a benefit for the profession as a whole. Two of my partners in our group practice do not have undergraduate degrees and are outstanding doctors of chiropractic. Despite this fact, I believe Dr. Winterstein's move to raise the standards at National College of Chiropractic should be applauded (Editor's note: see "NCC Raises the Admission Standard" in the September 20th issue of DC or on line at http://www.chiroweb.com/archives/17/20/12.html ).

Let's face reality. The reason most of these colleges do not raise their standards is fear of losing new students in their tuition-driven colleges and universities. To that end, I will copy this letter and send it along with a donation to Dr. Winterstein and National College of Chiropractic. I would ask that others who feel the entrance standard should be raised could help make that happen by financially supporting the chiropractic college of their choice to reduce the extreme dependence on tuition.

Thank you, National College of Chiropractic, for taking such a brave and bold step in the right direction for our wonderful profession.

Mark A. King,DC
Cincinnati, Ohio
makmlcc@aol.com

Dear Editor:

David Koch,DC's article in the September 20 issue of Dynamic Chiropractic ("Focus on the Vertebral Subluxation: Open the Conversation Today, Lay the Groundwork for Tomorrow"; see http://www.chiroweb.com/archives/17/20/09.html ) calls upon the profession to rally around the subluxation as a public relations/marketing strategy. I have two objections to offer.

First, Dr. Koch's assertion that "... almost every member of our profession, regardless of philosophic paradigm ... would agree that the subluxation is integral to chiropractic." There may well still be a majority of chiropractors who adhere to, or at least pay lip service to, the meaningfulness of the subluxation complex (VSC), but I'll guess that this majority is proportionately smaller than at any previous moment in the profession's history. Partial confirmation of my suspicion may be found in the recent discussion concerning the viability of the VSC as a research construct which reportedly took place at the Palmer-sponsored Research Agenda Conference. (I bow to Dr. Koch on this detail, since he was present and I was not.) Further confirmation may be found in the growing number of scholarly works from within the profession which in recent years have challenged the meaningfulness of the traditional chiropractic lesion (Haldeman, 1999; Nelson, 1997; Seaman, 1999).

Second (and more important) is the continuing reality that the meaningfulness of VSC has not been scientifically established. There is no gold standard for the construct (Keating, 1996). Notwithstanding consensus definitions on conceptualization (Association, 1996) and political maneuvers to have the subluxation declared the exclusive province of chiropractors within Medicare reimbursement, no one has yet demonstrated that any operational definition of VSC is meaningfully related to health or illness. Neither has it been experimentally demonstrated that detection and correction of this inadequately operationalized phenomenon (if it exists) will produce any change in health or illness. Claims from some corners of the profession, to the effect that subluxation is "validated" by deductive reasoning alone, or that the demonstrated value of manipulation/adjustment "proves" the meaningfulness of VSC, or that no one can realize their maximum "potential" if subluxated, have no credibility within the scientific community. I continue to believe that the subluxation complex, if valid, could be scientifically demonstrated (Keating, 1996), but perceive little motivation among the VSC's most vocal advocates to do the hard work that would be necessary to critically investigate the construct.

Given the lack of evidence to substantiate the subluxation complex, efforts to promote chiropractic by association with this elusive spinal target seem like folly. The subluxation complex may not be real, in which case mounting a PR campaign organized around the VSC amounts to building a house of cards. Even if chiropractors are some day able to validate some version of the subluxation complex, to promote the (currently unproved) construct now is unethical.

Members of scientific professions ought not make claims for unproved theories and methods.

Dr. Koch recommends that the profession proclaim "Chiropractic: Correcting Subluxations Since 1895," but is this true? Given the legitimate uncertainty about subluxation complex, should the profession hang its hat on this hypothetical construct? Should marketing needs supercede scientific and professional values?

References

Association of Chiropractic Colleges. Position paper #1. Journal of Manipulative and Physiological Therapeutics Nov/Dec 1996;19(9):634-7.

Haldeman S. The basic science of the subluxation. Presentation to the Los Angeles College of Chiropractic, March 25, 1999.

Keating JC. To hunt the subluxation: clinical research considerations. Journal of Manipulative and Physiological Therapeutics Nov/Dec 1996;19(9):613-9.

Nelson C. The subluxation question. Journal of Chiropractic Humanities 1997;7:46-55.

Seaman DR. Antiquated concepts related to chiropractic technique. Part I: a case against mental impulses and nerve interference. Chiropractic Technique Aug 1999;11(3):95-100.

Joseph C. Keating Jr.,PhD
Professor, Los Angeles College of Chiropractic
Whittier, California
jckeating@aol.comjckeating@aol.com

Dear Editor:

While many people are open to alternative healing, they are still not open to chiropractic. Here in this suburb of Boston, the medical mecca, people don't consider chiropractic as a form of alternative healing. When I do outside promotional events once a month, I find that people see chiropractic as only for back pain. This perception has a lot to do with the way the members of our profession market themselves.

For instance, a chiropractor has an advertisement on the wall at my gym. It says he offers fast relief for neck and back pain. This doctor doesn't understand how much he undermines the public perception of chiropractic, but he does.

I show a video to all new patients which shows children being adjusted. New patients are very surprised to realize that chiropractic is for kids as well as adults. When asked what I do, I now say that I am a "holistic" doctor with a focus on chiropractic. This always opens the discussion. Even when I say this, people automatically assume I use herbs, supplements, acupuncture, etc, but I don't. They don't see chiropractic as a holistic approach to health.

When I used to say chiropractic, the discussion would be limited because people knew (or believed they knew) what I did: treat back and neck pain, based on the marketing of other chiropractors.

I have found that without my weekly "chiropractic orientation," people can come and go and still never have a clue. While their neck discomfort resolved, it never occurred to them that their children's chronic ear infections merit chiropractic care. What startles me further is that only a few chiropractors make it a policy to educate their patients with a lay lecture. It seems that we deserve the lot we are.

Dana MacPhee,DC
Needham, Massachusetts
drmacphee@aol.com