In the Meantime

One of my favorite times in the day is in the early morning hours, before anyone else is awake -- when it's quiet and I can study. The rest of the day is spent at work, being with my family or writing. But the early morning is all mine and the cat's, if he says he wants out.

To give myself enough time, I usually get up about 3:30 a.m. This might sound a little strange, but it works for me.

For the last week or so I've been rereading Richard Schafer's latest text, Clinical Chiropractic -- The Management of Pain and Disability -- Upper Body Complaints. The more I read it the more I appreciate its intrinsic value to my practice. Page after page reveals substantive information that can be readily applied in any chiropractic physician's practice. A literal candy store of ideas filled with delicious non-fattening diagnostic and therapeutic confections. The reader is encouraged to go from one section to another because it's a reference text. If I had a patient the day before who complained of vertigo, I'd go to that place in the book and read about its definition, background, the tests needed for a satisfactory diagnostic workup, the eclectic diagnostic aids, suggested areas of specific spinal correction, adjunctive therapy which may include all kinds of reflex and trigger points, and nutritional therapeutic suggestions. When warranted, there are sections on the use of specific forms of physiotherapy as I go from vertigo to cardiac arrhythmia, and from cardiac arrhythmia to diabetes insipidus. The book is a compendium of diagnostic and conservative therapeutic protocols with associated illustrations, charts, and tables. So valuable is this text to my practice that I have one copy at home and another at my office.

One of the things I like most about the volume is its shameless promulgation of conservative eclecticism. No excuses are proffered. No hang dog nonsense about how we can't prove every last comma, colon or period of a therapeutic hypothesis. It's an "it seems to work in most cases without hurting the patient so let's try it" kind of book. It's my kind of book.

It seems both tragic and professionally dangerous that the trend always seems to be toward "playing it safe." The result is that our schools increasingly mirror our professional fears and insecurities and are now vigorously pursuing the instruction of chiropractic nerdism.

To be a chiropractic nerd you have to devote a good deal of your time trying to be an "official" scientist. This means that as long as the medical profession says or does something it's "scientific" until something more medically scientific comes along. Many of our schools are using medicine as a professional paradigm. In other words, we're having students taught that a profession like medicine, with little valid "scientific" proof of the efficacy of most of what it does, a profession that statistics show kills thousands of Americans every week, a profession that admits that two-thirds of the drugs they insist on pouring into your body have no value -- while all of them could do serious harm, a profession that with little more than four years of professional education feels emboldened to advise you on everything from nutrition to physical therapy without having studied the subjects -- is to be the role model for the chiropractic student.

To make things even more alarming, we're beginning to grow resident researchers whose duty seems to be to live in a world of doubt. Over the years I've read many research papers and can't remember reading anything more than qualified conclusions. The papers always seem to end with such statements as "It appears that the preceding might indicate that the assumption of this study merits further consideration on the possibilities of the hypothesis under consideration." The only conclusions I've ever read was that more research is needed.

Researchers live in a test-tube world of doubt. They play games of researching the research of the researchers, who have researched other researcher's research. This is fine for this is what they're paid to do -- research. But then there's the real world out there. You know -- the one where some chiropractor actually touches the patient's spine and makes an adjustment. This is a world where a patient might tell their chiropractor that their allergies are better and their blood pressure is lower. Are we expected to deny the clinical possibilities of structure affecting function because we can't prove the mechanics of this hypothesis through research?

Research valid or otherwise, never seems to slow down medicine. They'll stick a bunch of needles in some lab rats and if enough don't die in the process, are just as likely to prescribe the poison to their patients, telling them to "try this." Medical science? Hmmm. And let's not forget the osteopathic branch of medicine and their own postulation of the validity of the somato/visceral reflex and the therapeutic value of osseous manipulation. But that's okay because the word "medicine" is in their name.

Before we paint ourselves into "a crick in the neck -- low back pain" profession, we should do what our medical paradigm does -- give a healthy nod to our budding researchers -- every profession needs more and more research -- may their numbers increase and the wind be always at their backs -- but get on with the business of healing instead of waiting for the pontifical blessings of those doing the research. If every profession waited for the absolute proof of the value of what they did, we'd all be staring at the ceiling watching the paint peel or counting the liver spots on our hands.

So, let research challenge the value of the chiropractic adjustment and its effect on visceral function, but in the meantime let's adjust and help that patient with indigestion or cardiac arrhythmia.

Let the physical therapists get mad because we use physical therapy modalities, but in the meantime let's use iontophoresis to dissolve the calcium deposits and save the patient from cortisone or surgery.

Let the medics claim that all a person needs is "three square meals" a day to be nutritionally sound, but in the meantime let's give our patients specific nutritional supplementation to allow a faster and more complete resolution of a pathological process.

Let other professions cast their invectives at us, but in the meantime let's become fearless chiropractic physicians who are unafraid of taking the total responsibility for the total health of our patients.

All of the preceding can have a push in the right direction if, in the meantime, we read Schafer's latest book and implement the plethora of valuable ideas it offers.

And, in the meantime, let's let the researchers and scientific scientists research each other and us into oblivion, but in the meantime -- I don't know about you, but I've got things to do.

RHT