Can chiropractors learn anything from what happened to Senator Trent Lott?
In the words of historian Henry Steele Commanger, "We may believe that our words - which we assume to express our principles - represent us more truly even than our actions, but to outsiders it is the actions that are more eloquent than the words."
Without presuming to judge the intent of Sen. Lott, the facts remain that at a birthday party for a friend and colleague, a few misspoken words caused an avalanche of criticism, and ultimately the stepping down of an extremely powerful figure in the United States Senate. What happened? Why did the comments of Sen. Lott become the lightning rod that served to undermine the entire leadership of the Republican Party on the heels of such a resounding victory in the November 2002 election?
Historians and pundits will discuss and debate this issue ad nauseam, and no one will ultimately know why one powerful political figure is brought down, while another creates nothing more than a blip on the political radar. More important to me than this actual event is the question, "Can chiropractors learn anything from this incident?"
What are doctors of chiropractic saying that carries powerful messages about who we are; what we do; how we do it; and why we should even be considered in any health care debate. What we are saying and doing, individually and collectively, is what we will be judged by.
Look at the current dispute regarding the Council on Chiropractic Education (CCE). Across the Internet, in tabloids and in seminars, messages are voicing completely opposite positions regarding our accrediting agency.
One group is suggesting that doctors of chiropractic write to the CCE and the Secretary of Education "protesting" and denouncing the three proposed revisions to the CCE Standards for Chiropractic Programs and Institutions. Another group is urging that "support" letters be written to the Secretary of Education on the very same proposed revisions.
The message will clearly be mixed and confusing to the Secretary of Education. How is the profession viewed by these governmental agencies and elected or appointed officials, when they are confronted by these confusing, polarized positions from within what they believe is a single, unified profession?
The Veterans Administration (VA) and Department of Defense (DoD) chiropractic programs are sending another set of "mixed signals" to the DoD, the VA and to the various individuals who will ultimately decide upon the fate of the chiropractic profession in these programs. It's the same profession, but with completely opposite outcomes and objectives being espoused by groups who "claim" to represent and speak for the profession. What is needed is a responsible position that can be understood and supported by these agencies.
Within the profession, emotions run high during these debates, and the outcries for justice (depending on the side you are on) are frequent. Various philosophies of chiropractic often enter this emotional debate to assure even more confusion, as the discussion ranges from a religious adherence; to dogma; to a position that philosophy is nonessential to a chiropractic practice.
Respective of the debates that go on within the chiropractic profession, the spillover to other arenas is much the same for chiropractic as were the remarks made by Sen. Lott. The important thing to remember is that there are consequences to pay for each and every "unfortunate remark" or action undertaken by chiropractic, regardless of how innocent or inadvertent they are.
Meet the New Boss - Not the Same as the Old Boss
From the political point of view, the new and most powerful figure in the United States Senate today is a medical physician. Listening to him speak, the humanitarian and compassionate side of Sen. Bill Frist comes through loud and clear. His remarkable and stellar ascent to leader of the Senate is evidence enough of his political prowess and sharp intellect. He will use these very tools in his deliberations of every legislative initiative, particularly as they relate to future health care reform.
Sen. Frist has suggested that his views are often contrary to his colleagues because he takes a "long-term view" of each issue versus the "short-term view" until the next election held by a large segment of Congress. He often analogizes his view as being influenced by his training as a cardiac surgeon, in which his view was not to "fix the heart" for the moment, but to fix the heart for decades. He has said in various interviews that he is a scientist, and he reads the scientific literature and understands the scientific process. How can his mindset and scientific thinking influence the chiropractic community in our quest for recognition, inclusion, advancement, parity and equality?
Two issues immediately present themselves to me as I write this column in January 2003, at the beginning of a new Congress. The first issue goes to the heart of the thinking of the new Senate Majority Leader; he uses a science-based thought process. If that is the case, where have we, as individuals and as a profession, gone wrong in the past? We make claims for the clinical art of chiropractic that are not currently justified by available scientific evidence, or which are intrinsically untestable. As a profession, we claim we are a philosophy, science and art, and yet we often use philosophy as if it were a religion; we use the art as if only chiropractors could acquire the skill; and we abuse science by continuing to assert public claims using theories that, to date, have not been validated.
The reasons we respond as we do are really not for discussion at this time, but we can speculate that it is primarily because our education and training for many years largely ignored the science pertaining to the methods and validity of knowledge. As a result, many within the profession continue to espouse unsubstantiated claims for beliefs that have little or no scientific validation, and often do not recognize they are making these claims.
Field practitioners, who experience results every day in practice, respond: "Isn't that scientific proof enough?" Unfortunately, the answer is no. There is a huge difference between using unproven methods in the offices, and making claims outside the clinical setting. The fact that doctors are licensed to "practice" provides the authorization to treat people in their office based upon their education, training and clinical judgment.
All doctors (generally DCs, MDs, DOs) use methods that have not been proven, but are often clearly justified based upon the potential benefits, risks and quality of life the patient is willing or not willing to endure. The clinical practice of chiropractic (and the utilization of unproven methods) is not the same as publicly making claims for unproven methods. This fine line of distinction often makes the difference between the profession being viewed as "anti-scientific" or "pseudo scientific," instead of as a responsible healing profession.
It will really not matter to Sen. Frist whether the violations of scientific propriety by the chiropractic profession are motivated by economics, ignorance or the best intentions to help humanity. The end result will be the same: a reinforcing of an attitude that chiropractic is unscientific. His views, particularly in his current leadership position, will be significantly altered positively or negatively by what we proclaim chiropractic to be.
The profession knows well the challenge offered by C.O. Wakins, DC: "Let's be bold in what we hypothesize and cautious in what we claim." With this kind of thinking as the foundational basis for the actions of the chiropractic profession in 2003 and beyond, every DC can still practice the philosophy, science and art that were taught in our educational institutions, while still recognizing that the gap between practice and science is huge. If we maintained this view, Sen. Frist and the wider health science community would understand that chiropractors constitute a responsible provider group.
The second issue is about personal involvement by every practicing DC. Yes, there are many reasons why DCs do not belong to state or national associations. Those reasons are choices that the individuals make, and they ultimately will have to accept the consequences of their decisions. However, in today's electronic world, whether you are member or nonmember; rural or urban; conservative or liberal; or young or old, each of you as a practitioner has the availability and ability to let the current leadership know (not guess) what you think. You can send an e-mail at no cost to your state or national associations. You can send an e-mail to Dynamic Chiropractic (editorial@mpamedia.com) in support of one position or another. You can send a letter to the CCE and support its efforts. At least the current leadership will have some firsthand information about the number of doctors who truly feel we need to advance our profession by elevating our educational standards. They will know that the vast majority of the profession truly is committed to higher standards of accountability and responsibility.
It takes nothing more than a letter, an e-mail, a phone call, or a moment to register your views on where the profession needs to go. Can we allow "apathy" to continue to be the dominant factor in the direction the profession will take tomorrow? "Do what you can, with what you have, where you are," is perhaps the most promising advice for the new year. We cannot afford to "look back." We are not going that way!
At this moment, you may be thinking that my suggestions sound good, or perhaps crazy. Either way, bear in mind that ignoring a problem in the hopes that it will go away solves nothing. In fact, ignoring the problem usually results in a larger problem.
Commitment and persistence are all that is needed for chiropractors to achieve any of our goals. Commitment simply means, "no excuses." It means doing whatever it takes to achieve our goals. Persistence means believing in the integrity of our goals, and a willingness to overcome any fear by action.
I am struck by the simplicity with which many of our problems can be solved. It is the power of each and every individual doctor of chiropractic recognizing that special skill to perform the art of chiropractic, the need for an understanding of the philosophical premises and scientific propriety, and an unwavering accountability to offer the science of chiropractic in a fashion supported by evidence.
So, what can we learn from Sen. Lott? Each and every word chiropractic utters will be listened to, analyzed, researched and ultimately judged. The advancement of the profession will no longer be predicated upon what was, but rather what will be. In 2003, we have an opportunity to speak up, clearly and responsibly, and to recognize that science has entered the halls of Congress.
Louis Sportelli, DC
Palmerton, Pennsylvania
