"Thinking Broadly"

I recently read an article in the December 1991 issue of Discover magazine, "The Shape of Life." It was about Mimi Koehl, a research scientist in the field of comparative biomechanics -- how living structure is related to living function, particularly with regard to survival or evolutionary value. Using models of the various creatures she studies, Koehl attempts to answer questions on things such as why insects developed wings or how and why jungle frogs developed the ability to "parachute" down out of trees. Her work impressed me as both fascinating and fun.

It wasn't the stories about Koehl throwing plastic model frogs off her balcony or roasting model bugs to see how they dissipated heat that I will remember most. It was a brief -- merely ten sentences out of a full six-page article -- description of her research thought process learned from one of her graduate advisers that struck me as important to our profession. Describing her process of "thinking broadly," Koehl related how the adviser taught her how to go beyond quantifying biomechanical data, but to look instead for underlying principles. For instance, in researching, studying or measuring something, if you had a crystal ball and immediately knew the answer would be "x," what would you know then? Would it be worth measuring and why? In this process, repeated again and again for the hypothesis, one would approach an understanding of principles, not just a collection of minutiae.

So, how does thinking broadly relate to chiropractic? Well, for starters, let's look at something that has recently been hailed as a marvelous advance for our profession as the result of a study.

The study I refer to is the RAND study on manipulation for certain types of low back pain.

As featured in Time magazine, the study's panel report indicated that "chiropractic-style manipulation was helpful for a major category of patients with lower back pain. ..."

Now, there are a lot of chiropractors who are excited by this. There is no doubt that it was nice to see chiropractic mentioned in a worldwide publication other than the trade journals and professional papers, or as part of another smear campaign. Unfortunately, though, it appears that RAND assembled a panel of narrow thinkers. When they set out to see if chiropractors could treat low back pain, they revealed their narrowness.

Thinking broadly, if we knew that manipulation was effective for certain types of low back pain: a) What would we know then? Many chiropractors already claim this with great assuredness. b) Would it be worth measuring? If one thought the people who testified to their result were liars or fictitious, then yes. c) Why? The bottom line. I believe it is most evident that the benefits are in the form of third-party payers' lessened ability to deny low back pain claims. This is a rather narrow result.

What, then, are the principles discovered here? None. All that happened is that manipulation was tested for low back pain, something like a drug might be tested for a symptom -- "let's see what happens if we use this to treat that." We have gained one more bit of pragmatic treatment evidence, not an answer to an underlying principle.

If chiropractic care is supposed to be something that will benefit a person for a lifetime (and I've heard this from straights and mixers alike), how does this study help to show the principle? It doesn't. The result is that the American public will just have it reinforced that, as Time said in the November 4, 1991 issue on alternative medicine as well, "back crackers" are alternative medicine for treatment of low back pain and, as it reported in September, "about 1 to 20" will see a chiropractor.

For a lifetime? With narrow thinking like this, I doubt it.

James W. Healey, D.C.
Princeton, New Jersey