Editor, Joseph
B. Strauss, D.C., F.C.S.C.
Vol. 14, No. 3
April, 1998
In This Issue...
Chiropractic Commentary
Ad Hominum and Straw Man
Arguments
Manipulative Medicine
Is Chiropractic A
Health Profession?
Thoughts
You would think I had nothing else to read or nothing else to write about inasmuch as I am devoting an article on a number of articles in the tabloid that describes itself as "The Chiropractic News Source." These particular columns appeared in a mid-January issue and were written by different people but all present a similar chiropractic viewpoint, one that I find perplexing. The first article, on the front page, was about a Palmer College graduate who was arrested in Spain and currently faces a jail sentence for practicing medicine without a license. She maintains she was only practicing chiropractic as she was taught in college, which she was. The article makes it seem as though the Spanish government, in league with the medical profession, is conspiring to keep chiropractic out of Spain. But perhaps we should begin to look at things from others' perspective. The fact is that even though, to a casual observer, a chiropractic adjustment/treatment does not look like drugs or surgery, to anyone intelligently evaluating our profession by its objective there is little difference between the practice of medicine and what is being taught, licensed and practiced under the guise of chiropractic. Chiropractors perform medical tests and medical examinations, diagnose and treat medical conditions and then claim that what they do is not medical. We use archaic phrases like "We are correcting cause rather than treating effects." That may have worked 100 years ago, but the average medical doctor believes and probably is also treating a cause. He may give a pain reliever but he also gives antibiotics to treat the bacteria which he sees as the cause.
In this particular case, the poor chiropractor's defense was based upon "supporting documents" from the Spanish Chiropractic Association (AEQ), the World Federation of Chiropractic (WFC), and her alma mater (PCC). This, plus an endorsement of the WFC by the World Health Organization (WHO), was supposed to suffice in exonerating her. This is the classic faulty thinking of chiropractors. We believe if we can have strong political organizations or be endorsed by strong political organizations, we will be victorious. Most of the time this strategy has worked. However, in this case, the Spanish courts were not awed by AEQ, WFC, WHO, PCC or any of the rest of the alphabet. They said the chiropractor talks like a medical doctor, acts like a medical doctor, treats medical conditions as does a medical doctor (except for technique) and in every way appears to be practicing medicine. It sure seemed like medicine to them. An appeals court agreed.
Sometimes the human mind can fool itself into thinking unrealistically for so long that reality appears preposterous. I am sure this Palmer graduate and all her supporters think it preposterous that what she was doing is being labeled the practice of medicine. We have cried, "We're not practicing medicine" for so many decades that we believe it, despite the fact that somewhere along the line we have begun to practice medicine. Chiropractic, for all its claim as a beleaguered, poor defenseless profession has, by political means, convinced the WHO, fifty state legislatures, the US Government and most importantly itself, that it is not medicine. Like the children's tale, "The Emperor's New Clothes," the Spanish Government watched the parade and calmly said, "But it is the practice of medicine!" We better hope that as in the story, the rest of the world does not follow the logic of Spain and come to the realization that there is no difference between medicine and chiropractic, at least not enough to necessitate a separately licensed profession. The fact is that ninety-seven percent of chiropractors are practicing medicine, perhaps only a drugless, manipulative brand of it but medicine nevertheless. This is not a criticism of the chiropractor arrested in Spain. She was taught medicine under the title "chiropractic" in college like thousands of other students in almost every other college.
If the chiropractic that is practiced today, in keeping with the various state laws, was presented to any legislature and they looked at it objectively like the Spanish government did, they too would label it the practice of medicine. Chiropractic cries about its poor political state against the Goliath of medicine. History shows that chiropractic has been the most or one of the most powerful political lobbying forces in this century. Who else could have convinced fifty states to license chiropractors to practice medicine without any responsibility to the medical community or the medical profession and without going through medicine's rigorous education, training, and examination process? Chiropractic got legislative recognition as a separate and distinct profession and is now practicing a form of medicine because of one of two reasons. It is possible that those that started this profession had a vastly different idea of what chiropractic was and those that have come along later with a powerful, political lobbying effort have changed it into medicine. The other possibility is that those that began our profession lied to the state legislatures when they said they really were not medicine and that they wanted to do something different when all along their master plan was to do everything a medical doctor does but perhaps a little more conservatively. Either way it does not speak well of the character of this profession. I feel bad for the young chiropractor in Spain. I am sure she worked hard to build a practice and will now have to leave it and the country to avoid incarceration. But I feel worse for a profession that has evolved its practice to a state that it cannot prove in a court of law that its practice is not medicine. One would think that after 100 years we would have clearly defined what we do as not the practice of medicine. It seems that just the opposite is true. We have clearly defined what we do as the practice of medicine.
In a second article, a monthly columnist discussed lessons that the chiropractic profession can learn from Saddam Hussein. The writer contrasts the loyalty of the people of Iraq to their leader and their willingness "to give up their very life for a cause" with the complacency of most of the chiropractors and the fact that state organizations have to plead for support. The chiropractic writer suggests that both chiropractors and chiropractic organizations take a good, hard look at themselves in light of the fact that organizations get little support in their attempts to advance the profession and that chiropractors are always asking, "What's in it for me?" He is making a very important point, but I find a problem in his contrast between the Iraqis' fervor and the chiropractor's apathy. He is comparing apples and oranges.
It is perfectly acceptable for a chiropractor to ask, "What's in it for me?" with regard to his state or national organization because that is how these groups have marketed themselves. They project themselves as fraternities or trade unions dedicated to the good of their members. If that is their role, then chiropractors should be questioning them. The author contends that as professionals we have a higher standard of living than non-professionals. While that is true, it has nothing to do with the state or national organization. It is the result of years of study (and the expenditure of great sums of money) before anyone joins an organization. The fact remains that the average chiropractor is worse off today than he was 10 years ago and his standard of living seems to be slipping lower and lower. Interestingly, while the national and state organizations lament the lack of membership, support and involvement, I am amazed that anybody at all joins the ACA, the ICA or any state organization. There is simply nothing in it for them where they have been promised there would be.
Here's the difference between the Iraqis and the chiropractors.The chiropractors are serving themselves and their profession and that is selfish. When they do not seem to be rewarded for their efforts and dues, they drop out. The Iraqis are not in it for themselves or even for Saddam. They are serving Allah (or believe they are). A person serving for selfish reasons will never be as committed as someone serving for faith or love of God. The former will quit if they are not rewarded, the latter sees serving as their reward. Chiropractors will not support an organization that has allowed their standard of living to slip. The Iraqis think dying for Allah is a reward in itself. Chiropractors will not die for chiropractic. In fact, I believe the days of going to jail for chiropractic are even gone. Who can have a fanatical fervor for something that only gives you, as the writer says, "Money, prestige and the ability to practice independently," especially when the amount of all three is decreasing. In the same sentence he asks where we would be if those that preceded us "had felt the same indifference toward supporting the advancement of chiropractic?" The key word is chiropracTIC. To our chiropractic pioneers, advancing chiropractic meant advancing the principle, the ADIO philosophy. Advancing chiropractic to the writer of this article has nothing to do with the philosophy, it has to do with the money, prestige, etc., of the chiropracTOR. It is the old TIC versus TOR issue. Those who went before us had the fervor, dedication, zeal, and commitment of one of Saddam's followers. They gave enthusiastically of their time, energy, professional life and yes, went to jail for a principle. With relatively few exceptions that is not what chiropractic is about today.
I would be remiss if I did not comment on those small exceptions. I believe that the FSCO-type chiropractor represents the kind of dedication and commitment that the writer is looking for. This national organization does not offer its members much except an opportunity to give, to work and to help perpetuate the idea that being subluxation free as much as possible benefits every aspect of an individual's life.There is no incentive toward or promise of money or prestige, but those that have that vision have as much dedication and loyalty as any of Saddam Hussein's followers.
The last article is by a chiropractor who seems to reject the vitalistic philosophy of chiropractic and promotes chiropractic as an alternative to medical care. This article's emphasis is on low back pain. He talks about the usual conspiracy between the hospitals, the doctors and the insurance companies to squeeze chiropractors out of the lucrative low back pain care despite it being more effective and less expensive. He cites the following average figures for low back pain treatment:
Chiropractic care $800
Non surgical hospital care $7,000
Surgically-resolved case $14,000
It would seem that something is wrong. Why would the insurance companies stand for chiropractic not being tried first when it is so much less expensive? Even more important, why are chiropractors being left out of insurance plans? There are hundreds of thousands, perhaps millions of people with low back pain that seek professional help every year. Perhaps the answer lies in the overall figures that do not appear in the article. Insurance companies are not really concerned about the above individual statistics. What they are interested in is the year-end bottom line. Chiropractic care costs on the average $800 per case. That means that 100 low back pain cases would cost the insurance company around $80,000. The same 100 cases treated surgically would cost 1.4 million dollars but probably less than one in a thousand low back pain cases ends up in surgery. Probably less than one percent ever end up spending $7,000 on non-surgical care. The vast majority of low back pain patients are given a muscle relaxant, a pain killer and perhaps a little physical therapy and told to stay in bed for a few days. And guess what? The majority get well. So the vast majority of patients' insurance companies pay $100 to $200 as opposed to $800 if they went to a chiropractor. Further, a number of really bad low back pain patients go to chiropractors and after $800 (or more) worth of care still end up with surgery. That savings of conservative medical care more than makes up for the few cases of non-surgical care hospital stays and the even fewer surgeries. What does all this have to do with objective straight chiropractic? Well nothing, except that if we are presenting chiropractic as a less expensive alternative to orthodox medicine, we are going to be left out in the cold. Perhaps we should stop presenting chiropractic as a substitute treatment for low back pain and present it as something else.
There is a growing rift between the chiropractic philosophers ("the innatists" as one chiropractor calls us) and the chiropractic scientists (those that want to place chiropractic on the playing field of science). The argument, however, ends up being one-sided against the philosophers and it is not an argument in support of science, but rather against philosophy. It is not that the scientists want chiropractic to be scientific, it is that they do not want it to be philosophical. Can it not be both? Can we not hold to our philosophy while explaining the science of chiropractic? I have never heard a philosophical chiropractor express a fear of science. On the contrary, every scientific endeavor that has been legitimate science has reinforced the philosophical chiropractic tenet. The philosophers are not afraid of science. We do not try to outlaw it, to belittle it or to claim that it has no value. Why then is the same consideration not given to the philosophy? Why are we being attacked, often personally, and why is it one-sided? We are not inhibiting the march of "chiropractic science" by suggesting that chiropractic has a philosophy to it. The philosophy does not denigrate chiropractic in the eyes of the scientific community despite the fact that they think it does? We are not presenting chiropractic philosophy as an alternative to chiropractic science. Why then this attack?
I would suggest that it has nothing to do with science and philosophy. It has to do with power, with fear, and with the desire to suppress the free exchange of thought, as well as the fear that logical arguments and reason will become issues for discussion in the chiropractic profession. That has always been an issue. It is a power thing, with both sides struggling for control in the profession. The scientists have politically destroyed the straight chiropractic accrediting agency with its emphasis on chiropractic philosophy. They have closed two of the three straight schools. They ban straight philosophical chiropractic speakers from getting on college campuses. The battle is not over philosophy versus science. It is over freedom of thought, freedom of expression, and the freedom to practice safe, legal chiropractic and to serve humanity.
Straw Man Arguments
The other attack on straight chiropractic is that, "It is dangerous because they do not diagnose." This straw-man attack has been going on for years. The scientists set up the false argument that philosophical chiropractors accept patients to cure all of the diseases and that they do not diagnose and refer out cases, hence they are a danger. They know that the philosophers do not claim to cure all diseases or any diseases. You are only a danger if you pretend to be able to cure any or all diseases without diagnosing them. Philosophical chiropractors do not do that and the scientists know that.
The above arguments have created a political and cultural war in chiropractic rather than an open discussion and exchange of ideas. The educational institutions, the profession, the scientific community and the public are the ultimate victims of this war.
It amazes me how we can hear something and it will not impress us until we have heard it three or four or even ten times. This is a great reason why we should not be reticent in repeating our philosophy to patients. How often do we hear patients say, "You know, I finally understand what you are saying!" Recently, I heard Reggie make a statement on tape. I have heard him make the same statement many times. He was talking about adjusting spines to treat back problems and he said that it was not chiropractic, it was "manipulative medicine." In the past when he has said that, I would say to myself, "Right Reg, you know that and I know that but the average backache chiropractor does not accept that." Today, his statement made a different impression on me. Perhaps in the past I accepted Reggie's statement on his authority, but this time I thought about it from a logical standpoint. If osteopaths "adjust" to relieve back problems and medical doctors "adjust" to relieve back problems, then it must be manipulative medicine. We talk about the medical doctors stealing chiropractic but we are helpless to do anything about it. Why? Because what they are doing is not chiropractic, it is the treatment of disease, it is medicine.
Our profession is stuck in a Catch-22. We worry that the medical doctors and the physical therapists will steal chiropractic, yet we cannot press the issue. If we do, it may dawn on someone that what they are doing is medicine, albeit drugless. Therefore what we are doing (i.e., treating conditions by adjusting spines) is also medicine. They are not stealing chiropractic, they are just asserting their right to practice a form of medicine that they had the right to perform all along. It just so happens that they have only recently begun to do it and we have been doing it for 100 years. It is still medicine and still their domain. They were treating disease before us.
If it is chiropractic, what makes it chiropractic? Is it chiropractic just because a chiropractor does it? If a chiropractor performed surgery would, that make it chiropractic? Of course, that is not logical. The issue is not, "Well, that is Reggie's opinion" or "That is your opinion," the issue is what is logical, and what is illogical? It makes sense that chiropractic and medicine are not the same thing and hence, should not be attempting to achieve the same objective. I am very comfortable with this logic, but I am also aware of the fact that some/many people are not. If we do not differentiate the two professions by their objective, then how would we differentiate them? I am willing to agree to search for a way to define our profession only if it is as logical as defining it by its objective. What other ways can we define chiropractic? By the way the state defines it? That would be allowing politicians to decide what chiropractic is. Should each of us define it the way we want? That would be anarchy and the public would never gain an understanding of it. We would have to forget about public education programs. We might be able to develop a public relations program to explain how great our education is in chiropractic, but they would still need to know the purpose of that education. Is it to treat medical conditions druglessly or is it something else?
It is not so important that we define chiropractic as it is that we determine the means by which we will or we can define it, one that makes sense. If there are any suggestions other than by its objective, I would like to hear them. In fact, I would like to make this a challenge. I would like to see the ICA, ACA or anyone else come up with a way of defining chiropractic that is better than by its objective? Perhaps readers or friends of readers can put their suggestions on the Foundation's Message Board (our web address is on the front page) for our consideration. The challenge is out there. I will look forward to these proposals.
Is Chiropractic A Health Profession?
[Excerpt from another soon-to-be-published book on Chiropractic Philosophy]
The title presents an excellent question, one that has been the topic of considerable discussion among the straight community. First, we need to get the legal aspects out of the way. The laws of most states have defined chiropractic as a health profession. So it is. Further, it appears that the Discoverer and the Developer of chiropractic desired that it be a health profession, so that would suggest further that it is. The real question then is should chiropractic be a health profession?! That involves philosophical discussion and since this is a philosophy book it would seem an appropriate place to discuss it. Changing definitions and laws is a political issue and we will leave that to the politicians. However, just because D.D. and B.J. made chiropractic a health profession does not mean it needs to stay one. It is my feeling that they set that course for chiropractic (as a health profession) long before they even realized the ramifications of correcting vertebral subluxation, ramifications far greater than health and disease. And just because they set that direction does not mean that we as a profession need to continue that course. Traditional chiropractors would like to continue the course set by the Discover and the Developer, that is why we call them traditional. On the other hand, most of the profession cares nothing for what the Palmers would want or ever wanted. In fact, they have charted a course in the opposite direction of D.D. and B.J., a course toward medicine. I do not think it is dishonoring to their memory or to their discovery to move chiropractic into new directions as long as it is within certain parameters. Who or what would establish those parameters is again a political issue not philosophical. It is my opinion that the present straight chiropractic movement is, and has been since the mid 70's, moving chiropractic in a new direction (i.e., away from health care without dishonoring the memory or the work of the Palmers).
A Thought on Monitoring Innate Intelligence
If you don't know whether a sign or symptom is good or bad to start with, how do you know if a change is for the better or worse?
Thought
The problem is not that our profession is unable to agree on a definition of chiropractic. The problem is that we have failed to define the practice of medicine or to accept how medicine defines itself. Most chiropractors define medicine as "anything I choose not to do."