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Never beneath My Dignity

Dear Editor,

I would like to second the comments made by Dr. Hammer in the article, "The Chiropractic Tunnel" (DC 1995;13(12):23,37). Pran Manga, PhD, has said that "ideology has a fixation on the minds of the believer." Too many in this profession choose to fixate on the ideas of our leaders of the past and present that tend to limit the profession rather than expand it. I choose to honor D.D.'s pronouncement: "I have never felt it beneath my dignity to do anything to remove human suffering."

At Texas Chiropractic College I was taught that D.D. said that disease is caused by irritation to the nervous system. That irritation can come from mechanical, chemical or psychological causes. D.D. postulated that the most noxious mechanical irritation is the chiropractic subluxation (a.k.a. joint dysfunction), but he did not say it was the only one. As Dr. Hammer notes, many in the profession believe that the "true cause" of a patient's problem is the subluxation. This then forces the patient to fit the doctor's ideology, not the doctor's available therapeutic measures to fit the needs of the patient.

Many feel that what makes us unique is that we adjust patients. I think what makes us unique is that D.D. left us with a different model of health care (or to some, neuromusculoskeletal health care). That model, I believe, is that we treat dysfunctional states of the neuromusculoskeletal system, or as Dr. Hammer calls it in his article: locomotor system dysfunction. I think we can also call it the subluxation complex.

The subluxation complex was developed by MPI's founder Leonard J. Faye, DC, as an attempt to explain the interaction between the mechanical irritations (joint and muscle dysfunction) and the pathophysiology that ensues. (I recommend Dr. Skip Lantz's chapter on the subluxation complex in Dr. Meridel Gatterman's new book, Foundations of Chiropractic: Subluxation.) If the dysfunctional state (the subluxation complex) is causally related to the pathology a patient has, then correction of the dysfunction will allow the body to heal the pathology, if possible.

The medical profession by and large ignores dysfunction and does not treat a patient until they find pathology. Slowly, as more members of our profession seek to limit our profession to only treating one dysfunction, the vertebral subluxation, the medical profession expands to fill the void we leave and treats all the components of the subluxation complex, without calling it that.

As Dr. Hammer says, many of our peers are creating a tunnel around our profession. This tunnel is narrowing and narrowing until the entrance to that tunnel for the patient to get in is too small, until patients won't come in to see chiropractors at all. They will go see others who do what we used to do: treat the dysfunction the patient has, not the dysfunction we want them to have, the subluxation. Find it (WHATEVER the IT they have is), fix it, and leave it alone.

"A man who knows that he is a fool is not a great fool."
-- Chuang Tzu

Stephen Perle, DC
Assistant Professor of Clinical Sciences
University of Bridgeport College of Chiropractic
Bridgeport, CT 06601
E-mail: perle@cse.bridgeport.edu

Dear Editor,

Congratulations on publishing Dr. Timothy Mirtz's article on the HEAL loan crisis. More than 18 months ago I obtained a copy of the Federal Register with the default list. At that time I wished someone with ability in statistics could write an analysis. But as time passed I noticed very little comment on the whole mess in the chiropractic media. The national leadership seemed unconcerned. The colleges were silent. It's like Ross Perot's crazy aunt up in the attic. No one wants to talk about it.

But it needs to be talked about and Dr. Mirtz's analysis will certainly help. All of us have been embarrassed by the news stories about "deadbeat docs." All of us who paid or are paying our student loan feel the frustration of seeing colleagues (and competitors) walking away from obligations.

As I looked over the list, it seemed that there were a lot of Life College graduates defaulting. Dr. Mirtz confirmed this. Wouldn't it be great if DC interviewed Sid Williams to find out why?

However, of much greater importance would be an interview with Jim Parker. Even though PCC is a big school, it has very few alumni on the list. Jim must be doing something right at his college and the profession needs to find out what it is.

I'm looking forward to Dr. Mirtz's other articles and the follow up stories it will generate.

Dwayne Borgstrand, DC
Red Lodge, Montana

Dear Editor,

After reading Dr. Schneider's article, "Another Look at Preventative Maintenance" ("DC" April 10, 1995), I wondered how someone could go through chiropractic college, be in practice for 12 years, and never see a scientific study from an indexed medical journal concerning the relationship between kinesiopathology and joint degeneration. A literature search in any medical or chiropractic library would turn up many studies which confirm that there is indeed an important relationship between joint movement and joint degeneration. Perhaps the reason that Dr. Schneider does not understand this relationship is because he spends most of his time on "several types of traction therapy" and "gentler techniques" and doesn't "routinely crack necks."

Studies have shown that the cracking noise associated with the adjustment is therapeutically important. It indicates a successful movement into the elastic barrier has taken place. If we are to restore normal function to the intervertebral joints, this type of maneuver is necessary. Gentler techniques will never have the same effect on the joint, on kinesiopathology, or the nervous system. Scientific studies concerning abnormal biomechanics and the relationship to degenerative joint disease are in the scientific literature. A good place to start would be with the following list:

Cyriax J, MD. Textbook of Orthopaedic Medicine.

Kirkaldy-Willis, MD. Managing Low Back Pain.

Videman T. Experimental models of osteoarthritis: The role of immobilization. Clinical Biomechanics 2: 223-229, 1987.

Kapandji IA. The Physiology of the Joints.

Polmoski M, Pericone E, Brandt K. Development and reversal of a proteoglycan aggregation defect in normal canine knee cartilage after immobilization. Arth Rhuem 1979; 52: 508-517.

Ressel DC. Disc regeneration: Reversibility is possible in spinal osteoarthritis. ICA International Review of Chiropractic, March/April 1989.

Restoring and maintaining normal spinal function will always be a chiropractor's highest calling. Because some doctors do not understand where, when, and how to adjust, does not mean that we should stop and wait for them to catch up. It only indicates how far we have to go in becoming the biomechanical experts. Research will keep chiropractors from the kind of "public embarrassment" that Dr. Schneider speaks of. The research is out there, but if we don't know about it, who will? I would encourage my fellow colleagues to become more aware of the increasing amount of science concerning specific manipulation and joint degeneration. Let's not replace it with personal opinion and skepticism.

Gregory Watson, DC
Waynesboro, Virginia

Dear Editor,

The Agency for Health Care Policy and Research (AHCPR) recommendations are not being utilized to the fullest extent. Some chiropractic colleges may want to consider offering courses to medical schools and medical doctors for postgraduate credit.

Educating the medical profession on the neurophysiological aspects of chiropractic care, and guidelines for referral to chiropractic care, will be of importance to them if the courses are marketed as malpractice prevention. Patients and attorneys will soon begin suing medical practitioners for "failure to refer" based upon the AHCPR recommendations if proper referral to chiropractors are not made.

Let's save the MDs down the road by teaching them how and when to properly refer to chiropractors. This is a nice way to open the lines of communication among the professions and educate MDs in large groups.

Interesting isn't it?

Dale Heil, DC
Baltimore, Maryland