On June 5, 1997, I had the opportunity to speak at the World Federation of Chiropractic (WFC) meeting in Tokyo, Japan. My topic was "In Support of Alternative Medicine," and was as follows:
The resolution that we are debating today (that chiropractic is a mainstream form of health care and not at all alternative in nature) clearly has a serious problem with the term, "alternative medicine." In looking over the arguments made in its behalf, I think that the overriding sentiment by far shared by all of us is to avoid getting trapped in an untenable position in today's and tomorrow's health care marketplace.
In all fairness, I do think that it is evident -- as I will show -- that the term has many definitions and has been associated with anything from structural integrity of the human body to the cosmic consciousness of the Rosicurians. It may be helpful, therefore, to divide alternative medicine as we know it into two polarities of interventions such as these, which we'll call "more established" and "more esoteric":
More established:
A. Chiropractic
B. Osteopathy
C. Acupuncture
D. Massage
E. Homeopathy
F. Chinese medicine
G. Herbal medicine
H. Biofeedback/Mind-body medicine
More Esoteric:
A. Shamanism
B. Hydrotherapy
C. Grahamism
D. Mesmerism
E. Therapeutic touch
F. Dianetics
G. Pentecostal healing
Calling something mainstream is not an absolute goal to be pursued at the expense of everything else. It cannot be put onto an absolute scale of "goodness."
Actually, by splitting the universe into the heavens of "mainstream" science and the inferno of "alternative medicine," as this resolution seeks to do, we are putting ourselves at greater risk than ever imagined.
Start with the assumption in the WFC resolution that mainstream = scientific, and that alternative = unscientific. This is almost a throwback to medieval religious intolerance, saying that Christian is "good" and anything else is "bad."
All we need to do is consider how few medical procedures (<15% to be exact) are documented in the literature. According to David Eddy, epidemiologist at Duke University, only 1% of these citations are any good. This already tells us that mainstream practices may not be the gold standard this resolution makes them out to be. Remember, mainstream is what gave us leeches and laughing gas in the past.
Look at how bereft of evidence such mainstream procedures as back surgery turned out to be in several government reports, not the least of which was the AHCPR report issued in late 1994, which was so critical of mainstream medicine that several political groups acting in its behalf moved to cut the AHCPR budget and derailed another set of guidelines directed for headache management in the process. Fellow delegates, if mainstream medicine is so politically secure and scientifically sound, why is it acting so defensively? Why is it acting so surreptitiously? Why is it acting so desperately?
Look at how such governmental bodies as the Office of Alternative Medicine (OAM) in the National Institutes of Health within the United States were set up -- not only on the basis of consumer demand, but upon the assumption that there are sufficient scientific bases to study at least some form of alternative care.
What is the physical evidence to support all of this?
Let's start with the historic NEJM (New England Journal of Medicine) article by David Eisenberg, published in 1993, which told us in no uncertain terms that within the U.S., in 1990, there were 37 million more visits to providers of alternative health care than to doctors of allopathic medicine. Furthermore, patients did not tell their allopathic providers of their wanderings but instead voted with their feet. I am sure that you are aware that chiropractic was listed among the most frequently used forms of health care in this paper.
Categorically shutting out the alternative model and blindly embracing mainstream in this resolution isn't just a shotgun marriage; it's an elopement -- and we haven't even checked the dowry!
The budget of the OAM, supporting research in a variety of fields of alternative medicine (including chiropractic), has increased by 50% each year, doubling in the past two.
The OAM has expanded into 10 centers of excellence at established medical centers around the United States to oversee research and develop clinical procedures, again including chiropractic. Alternative medicine is now taught in some form at nearly 50 major medical centers around the world.
Four new peer-reviewed journals in alternative medicine have appeared worldwide and have significantly impacted what used to be CHIROLARS. One journal, Alternative Therapies in Health and Medicine, has achieved listing in the Index Medicus.
Let us move on and consider the history of the term "mainstream." It turns out to be nothing more than the emperor's new clothes, a politically opportunistic and chimeric phenomenon.
Homeopathy, for instance, was mainstream until the Flexnor report was issued in 1910; then it was pushed to the sidelines. Such homeopathic centers of health care as the Hahnemann Hospital in Philadelphia quickly changed their stripes accordingly.
Perhaps the greatest achievement of the OAM was to reach a consensus definition of "alternative medicine," published in the journal Alternative and Complementary Therapies in Health and Medicine two years ago. This not only effectively removes the stigma from the term "alternative," you see, but it exposes that other term "mainstream" for what it really is (a politically dominant force only).
It is ironic that as chiropractic seeks to relieve joint fixations, this resolution clamps on a restriction of a different kind that I can't imagine anyone here really wants. It paints chiropractic into a corner by either:
- masquerading intervention for non-back conditions as mainstream; or
- denying that interventions for non-back conditions have taken place or should ever take place. This means that all research to date addressed to these non low-back conditions is inadmissible, and all ongoing and future research around the world is imperiled.
These are all the conditions that would be erased from chiropractic's agenda by this resolution.
In the words of Terry Malloy in Elia Kazan's classic film "On the Waterfront", this resolution is a "one-way ticket to Palookaville."
Alternative medicine is anything but Palookaville if you look at the AMA's own data (from the Council on Scientific Affairs) concerning referrals from allopathic providers. The message is clear: The public is in revolt. It seeks empowerment and will not buy into mainstream in its current state. What tempers mainstream and makes it acceptable? What leads us away from leeches, laughing gas, unnecessary spinal surgery, and a discontented public? You guessed it -- alternative medicine.
By categorically calling itself "mainstream" at the expense of failing to recognize either its non-low back pain research or its basic paradigm, chiropractic will assuredly strip itself of both its future and its identity. It will become a detached and groping entity, precisely as the notorious Flying Dutchman was condemned to sail the seven seas for eternity, without a home port.
Author's note: The resolution to condemn alternative medicine was tabled.
Referral Patterns to Alternative Practitioners (survey of board certified family physicians/internists)
Percent Expressing Willingness to Refer to Alternative Therapies
94%
90%
77%
66% | At least 1
At least 2
At least 4
At least 5 |
Therapies for Which Physicians Express a Willingness to Refer
86%
85%
66%
63%
56%
54%
47%
15%
6% | Relaxation Techniques
Biofeedback
Therapeutic Massage
Hypnosis
Acupuncture
Meditation
Chiropractic
Homeopathy
Megavitamins/Herbals |
----------- From the Report of the AMA Council on Scientific Affairs. (See "Report of Findings," Dynamic Chiropractic, May 5, 1997, p.3,4.)
Anthony Rosner, PhD
FCER Director of Research
Arlington, Virginia
