A Challenge to Dr. Ward's "Psychosomatic Connections"

The July 1992 issue of The American Chiropractor published the article "Important Psychosomatic Connections -- Diagnosing Hostile Processes and Murder from Their Associated Systemic X-ray Findings" by Lowell Ward, D.C. The author claims that during the past 18 years he has "developed a well-documented high technology structural systems evaluation process, which has greatly enhanced my far-reaching discoveries."¹ He further states that he has "been able to develop a basis for identifying various forms of murder experiences from documented structural patterns in patients."¹

Dr. Ward challenges the reader to be "open-minded enough to read this article and creatively develop the unlimited possibility."¹ Unfortunately, he never tells the reader what "possibility" he is actually talking about, but does spend almost the entire last page of the article asking a long series of questions, rallying the reader to his point of view. He states: "Hopefully, in the future, funds and opportunities will be presented whereby we can prove this process with normal scientifically-accepted procedures."¹ A few sentences later he asks: "Should we just stop all our creativity because there is no 'accepted' scientific proof yet?"¹ He further offers to provide "problem case evaluations now."¹

As I'm a strong believer in both creativity and science, until Dr. Ward has the answers to many of the questions he poses in his article, he has no business marketing his self-professed skills in "mental-emotional-structural evaluation." Doing so is scientifically and socially irresponsible.

I would, however, like to present Dr. Ward with a challenge. Below is a list of procedures and suggestions for a clinical research protocol that, if satisfied, would indicate that his diagnostic test could be considered useful. It is clear from his writing that he already believes that the "mental-emotional-structural evaluation" has utility ("utility" meaning that both the clinician and the patient benefit from a significant increase in knowledge as a result of completing the test). If his test does indeed have this attribute, then like the best literature, evaluating diagnostic tests experimentation of his procedure should meet most or all of the eight standard criteria.²

1. A "Blind" Comparison to a "Gold Standard." Translating this in terms of Dr. Ward's project, the following is required: First, since it is unlikely that "murder hostility" can be objectively diagnosed by any means, I would suggest that he assemble a panel of at least three expert judges (qualified psychologists who have an expert reputation in dealing with patients with various forms of hostility) and use a "majority opinion" as a method of determining the existence of "murderous hostility" in a series of typical patients. The term "murderous hostility" must be clearly and objectively defined, both in terms of quality and quantity. For example, does one thought of murder constitute this "diagnosis" or must there be many? Standardized, validated interview techniques would have to be used for these subjects, and the reproducibility of these techniques would have to be shown for the interview process to be considered an appropriate part of the "gold standard."

Further, the completion of the x-ray analysis and "systemic spinal measurements"1 would have to be done independently of the analysis by the panel of judges. That is, the person(s) completing the proposed evaluation would have to be "blinded" to the actual diagnosis (or lack thereof) of "murderous hostility."

2. Setting and Study Filter. It will be important to define where the study will take place, to assure that the setting itself is free from bias, and to allow for the greatest generalizability of the results to the average practice setting. Further, for purposes of generalizability of the results, the method by which subjects are taken into the study must be carefully considered. If only volunteers are used, for example, it may be that subjects would discuss their "murderous" intent differently than they would if they were not given a platform such as a study in which to discuss it.

3. Spectrum of Subjects: The study will require the selection of subjects with varying degrees of "murderous hostility," since varying degrees exist in the North American population. A sample representing the full spectrum of this disorder will provide the most accurate estimate of sensitivity and specificity for the proposed test.

4. Definition of "Normal": As per the required spectrum, and the need to determine the sensitivity and specificity of the procedure, Dr. Ward would be required to have a certain number of "normal" subjects in his population. The definition of "normal" must be a sensible one. Will he decide that "normal" means only those subjects with absolutely no indication of "murderous hostility" as determined by all three judges -- or is some amount of hostility to be considered "subthreshold" and thus "normal" in some way?

5. Test Described to Permit Exact Replication: In order for Dr. Ward's testing procedure to be considered appropriate for use by other practitioners, it must be possible to reproduce the test procedure itself. Studies regarding diagnostic tests should publish their procedures in such detail, that others will be able to obtain the same results by following the written summary of the methods used.

6. Reproducibility of the Test Results and Observer Variation: Since it appears from Dr. Ward's article that x-ray analysis is to be used, reliability must be established: a) in x-ray taking techniques; b) in the ability of a single reader to get the same result a second time (intra-examiner); and c) in the ability of different readers to get the same result in each test (interexaminer). The results of these evaluation must also be published.

7. Contribution of Test: The overall role of the test must also be defined. Will the test procedure make the diagnosis, or must it be used in conjunction with other procedures and other professionals?

8. Utility: As stated earlier, it seems clear that Dr. Ward believes this already exists. However, given the paucity of data he presented, these questions must still be asked: Is there a need for this test? Is it more definitive and/or cheaper than current methods? How has this been proven? Again, the proof must be published.

Ah, but Dr. Ward mentions funding. Should money be a barrier to the establishment of good scientific evidence for his discoveries? Is he willing to legitimately seek beyond the limitations of time and money in order to evaluate the "discoveries" he's made? In fact, is he willing to reach for the moral, ethical, and intellectual integrity necessary for our profession to continue to grow? Creativity and science are not mutually exclusive, but rather complementary.

There is a way for Dr. Ward to assess his ideas, if he's willing to pursue it.

References

1. Ward L: Important psychosomatic connections -- Diagnosing hostile processes and murder from their associated systemic x-ray findings. The American Chiropractor, July 1992, pp 22-30.

    

2. Sackett DL, Haynes RB, Guyatt GH, Tugwell P: Clinical Epidemiology: A Basic Science for Clinical Medicine, 2nd ed. Little, Brown & Co. 1991; Boston, pp 51-68.