Lead the Horses to Water

Despite more than six decades of sustained efforts to improve the quality of chiropractic education, the graduates of the 1990s continue to leave their alma maters without a thirst for the scientific and scholarly literature in the profession. Perhaps this is due to the youth of our scientific metamorphosis: the premiere science journal of chiropractic, the Journal of Manipulative and Physiological Therapeutics (JMPT), is only 16 years young. Perhaps the antipathy seen among our students toward the quality periodic literature reflects faculties who do not follow the knowledge base in the profession, or who do not make use of this information in teaching the chiropractic arts (Rupert, 1993). Perhaps the academic ennui of our students and graduates bespeaks the lack of selectivity in the colleges' recruitment and enrollment practices. Almost anyone who can meet the minimal basic science prerequisites and come up with our hefty tuition is accepted. Our poverty-stricken, tuition-driven, institutions cannot afford to turn many applicants away; some schools seemingly would not be so disposed even if they could (being more concerned with quantity than quality in education). Perhaps the general lack of interest in the chiropractic knowledge base is a reflection of our traditional "anti-intellectual" (Coulter, 1990) attitudes towards higher education. There may be other reasons as well.

Anyone who doubts the prevailing disinterest in hard scientific data and in scholarly thought should consider the following sobering statistic. In this profession of 50,000+ doctors, fewer than 10 percent subscribe to the world's only blind-peer-reviewed, international, interdisciplinary, indexed chiropractic science journal, the JMPT. Of course, someone will rebut that although s/he doesn't subscribe, s/he always read grandmother's copy. And, of course, we're all aware of the long lines that form in front of chiropractic college libraries when a new issue of JMPT is published. However, after 10 years in chiropractic education I am more familiar with scenarios like the following:

1. A 12th quarter student (intern) is preparing to graduate, and casually remarks that he was a respiratory therapist before enrolling in chiropractic college. I ask him what he thinks about the outcomes of various pharmacologic approaches to asthma and respiratory distress compared to manipulative methods. He has no knowledge of the latter, and is amazed when I walk him over to the college library, introduce him to the CLIBCON Index to the Chiropractic Literature and the Chiropractic Research Abstracts Collection, and quickly pull out several studies of chiropractic care for these health problems.

    

2. A recent graduate has been hired as a "clinical resident" in a college clinic. He is also trying to build a private practice, and wants to disseminate research literature to patients and medical doctors. He's heard that I have had some experience in chiropractic research, and asks if I would please provide him copies of "the proof" [that chiropractic works!]. I point him toward the library; he heads instead to lunch.

    

3. A field doctor becomes irate when I do not agree that the Renaissance seminar group's compilation of 490+ references from the medical literature constitute "conclusive evidence" of the clinical meaningfulness of subluxation. My attempts to suggest that we have not yet established the validity and reliability of any subluxation detection-strategy only outrage the doctor further.

Well, it's not as though we don't make any of the periodic literature available to the next generation of chiropractors. I've visited all CCE-accredited colleges in North America, and at most of these the junk journals of the profession are distributed gratis to anyone who wants them. For the student who wants to learn about "Diagnosing Hostile Processes and Murder from their Associated Systemic X-ray Findings," or about "The Beginning of Knowing" (how one chiropractic college president talks to himself and his Innate talks back), or about how "Mikey was Brain Dead Until I Adjusted Him," or "The Slots: Is It All Luck? A Theory of Gaming Physiology," or "Quantum Chiropractic Psychoneuroimmunology and the Altruistic Chiropractor," these and more are readily available to anyone who visits campus. The gobbledygook is free; it's the scholarly journals in chiropractic that cost. The ludicrous in chiropractic is widely distributed (Nelson, 1993), the scholarly literature of the profession is not. Our students have considerable access to the former, but relatively little exposure to the latter. Unfortunately, and presumably as a consequence of their training, many in the profession cannot distinguish between the gobbledygook vs. quality information. Hart (1993) suggests that the differences among "scientific" vs. "unscientific" literature in chiropractic reflect the self-righteousness of those few folks who participate in chiropractic scholarship.

Like McGregor (1993), I do not recommend censorship. However, we could be doing a great deal more to get the good stuff to the next generation. One suggestion would be to raise student tuition by $6-9/quarter (or $8-12/trimester) and use the proceeds to purchase subscriptions to JMPT for all students. [Credit for this proposal goes to Gregory Plaugher, DC, assistant professor at Palmer College of Chiropractic/West and director of research for the Gonstead Clinical Studies Society.] The exact amount of tuition increase would depend on the size of the student body and the skill of the college administrator who negotiates with the journal publisher. Students would receive the journal at their home addresses, and would take with them something that will remain in their personal libraries throughout their careers. Regular exposure to the more critical literature in the profession would help to develop a taste for critical thought and the diversity of clinical and professional issue addressed in the JMPT. We might even anticipate that as students become more familiar with the current literature in the chiropractic art, the faculty would experience greater pressure to do likewise.

What about it, ye college administrators? Could we not do a much better job of leading the horses to water by placing the best chiropractic literature in the hands of the next generation? Would not more of our students develop a thirst for this knowledge if they were early on and repeatedly exposed to it? Would an additional $300-400 tuition over the course of 12 quarters (or 10 trimesters) be too expensive in light of the potential gain? Can the profession afford to continue to turn out doctors with little or no awareness of the evolving science of chiropractic, or with few of the skills needed to critically evolve it?

References

Coulter ID. Letter to the Editor. Journal of Manipulative & Physiological Therapeutics 1990 (May); 13(4): 234.

Hart JF. Letter to the Editor: Chiropractic magazines. Chiropractic magazines. Journal of Manipulative & Physiological Therapeutics 1993 (September); 16(7): 508.

McGregor M. Chiropractic magazines. Journal of Manipulative & Physiological Therapeutics 1993 (January); 16(1): 4-6.

Nelson CF. Five steps to your own technique: the Nelson method. Journal of Manipulative & Physiological Therapeutics 1993 (February); 16(2): 115-7.

Rupert RL. Letter to the Editor re: Chiropractic magazines. Journal of Manipulative & Physiological Therapeutics 1993 (July/August); 16(6): 426-7.

Joseph C. Keating Jr., PhD
Portland, Oregon