Volume 15, Number 2
Editor, Joseph B. Strauss, D.C., F.C.S.C
In this issue...
Subluxation Based Chiropractic
In the past I have made clear my disdain for the term "subluxation-based chiropractic." I have never liked it because I feel that any description with only "subluxation" in it is inadequate. The correction of subluxation is the means to an end. Unless you describe the means and the end, you have inadequately described your professional objective. Correcting subluxation can be done for many reasons including pain relief, curing disease or its cause, making money, etc. For the objective straight chiropractor, the objective or purpose is to enable the innate intelligence of the body to be more fully expressed. Admittedly, without including the means to achieve that objective, correcting vertebral subluxation, you cannot clearly define that you are a chiropractor. That is what words are for, to clearly communicate ideas. However, to include only what you do can be deceiving.
I have always felt that those who promoted the use of the term "subluxation-based chiropractic" over straight chiropractic or objective straight chiropractic did so to confuse or undermine the purpose of straight chiropractic. It is significant that objective straight chiropractic is unique, not like anything else. We are not therapeutic chiropractic with its treatment of musculoskeletal dysfunction. We are not traditional chiropractic with its "chiropractic gets sick people well." We are not "one cause" (i.e., vertebral subluxation) "one cure" (i.e., adjustment) chiropractic. Objective straight chiropractic maintains the unique goal of correcting vertebral subluxation to enable the innate intelligence to be expressed more fully. Nothing more, nothing less.
Have you ever noticed that the more people say on a subject, the more their true thinking or their true position emerges? I believe that having written this publication for almost 15 years I have made it pretty clear where I stand on issues. Recently, the subluxation-based chiropractors demonstrated the truth behind their position in an unprecedented fashion, making some powerful statements in print. It seems all along their goal has been to undermine straight chiropractic, to destroy the position that straight chiropractic is an approach to chiropractic that is like nothing else. That uniqueness has been the foundation of the straight chiropractic position for 25 years. It is why we resisted joining the CCE when all the other schools, including the traditional ones, jumped on the bandwagon and, in effect, obscured the difference. It is why we had to add the adjective "straight" to our colleges' names and ultimately, because those who would confuse said they were also straight, that some of us have tacked on the additional adjective "objective." It is true, you are either straight or you are not but we felt the need to emphasize that there is a difference, hence a different descriptive adjective in front of straight. But now their nefarious scheme is crystal clear.
In a recent subluxation-based periodical, written by the vice president of a subluxation-based organization, some very interesting statements were made in an article titled, "What Kind of Chiropractor are You?" The author of the article (a non-chiropractor) says that the terms straight and mixer "have now been replaced by the more descriptive terms 'subluxation-based chiropractors' and 'allopathic chiropractors.'" As a side note, who gave an insurance salesman the right to reclassify chiropractors and why did not anybody tell me this?! You would think that such a monumental change would have been jointly announced by the ICA/ACA/WCA/FSCO, not in a column usually dedicated to advertising a malpractice insurance carrier.
(To clarify, I submit the following diagram which demonstrates the various classifications since 1973.)
In 1973, it became clear that what had been recognized as straight chiropractic (hands only/spine only to correct the cause of disease) was no longer consistent with our increased understanding of the chiropractic philosophy. This created a split in the straight chiropractic community. Without the restraining force of the more philosophical chiropractors (those who would eventually become objective straight chiropractors), many straight chiropractors became conservative mixers. I am certain that being paid by insurance companies for certain therapeutic procedures also contributed to that exodus. Because of these changes, the need for a clearer/better classification of chiropractors to accommodate all schools of thought in a non-judgmental manner again came into question. The pure objective straight chiropractor's position is either that you are practicing (objective straight) chiropractic or you are practicing something else (medicine). In a strict sense, that is absolutely true. But in an effort to respect all legally acceptable approaches to the practice of chiropractic, we have developed more categories.
The author of the article ignores these categories entirely and goes back to before 1973 when there were only straights (what he calls "subluxation-based") and mixers. He does distinguish between two different types of subluxation-based practitioners. His categorizations follow.
Subluxation-based Class One: This group includes hands only/spine only chiropractors and those who use massage, hot and cold packs, orthotics, traction, extremity adjusting, non-invasive modalities, nutritional supplements and exercise as long as the above are used to "help patients hold their adjustments," to aid in the correction of subluxation, or to help patients live a subluxation-free life. There are major philosophical problems with that idea but that is not the issue of this article. The interesting part is that this category also includes objective straight chiropractors.
Subluxation-based Class Two: This group includes chiropractors who correct subluxations for the purpose of treating medical conditions, as long as those conditions are of a musculoskeletal nature. They diagnose and treat structural conditions and can use electrical stimulation, ultrasound, diathemy, whirlpool, cryo-therapy, homeopathy, etc. Remember they are still "subluxation-based".
Allopathic Chiropractor: This group includes the "doctor who focuses on full body diagnosis and/or treats specific disease and conditions." It is all terribly confusing and I believe it is meant to be.
The intent of the term "subluxation- based" is clear from this article. It is not just a nice way of describing 85% of the chiropractors who happen to share the fact that they check people for a subluxation regardless of the variety in intent, method or frequency. "Subluxation-based" is a term designed to do away with the "straight" in straight chiropractic and in so doing to destroy the uniqueness of the approach. By these classifications, everything may be lumped together in one of the two classes of subluxation-based chiropractic. However, the very nature of objective straight chiropractic does not allow lumping together. Objective straight chiropractic is separate and distinct. After all these years, the individuals and the two national organizations who perpetuate the term "subluxation-based" have finally shown that their true motive is to destroy not only the word "straight" but the practice. Clearly, it is time for those who see chiropractic as the correction of subluxation so the inborn wisdom of the body can be more fully expressed, nothing more and nothing less, to stand up and refuse to accept any validity to the term "subluxation-based." Objective straight chiropractic practice cannot be mixed with anything else, regardless of the altruistic motive (supposed or real) of the adjunct. Furthermore, I find it hard to believe that traditional chiropractors want to be lumped together with people who use physical therapeutics. For these chiropractors who practice in the traditional B.J. Model (chiropractic gets sick people well) it is time for some soul searching. They need to recognize that their relating to disease falls outside the realms of straight chiropractic and that really they are part of mixing chiropractic. No matter what kind of straight chiropractor you are, it is important to know that the term "subluxation-based" is a euphemism for mixing chiropractic. As an objective straight chiropractor I do not wish to endorse it or be a part of it.
Attacking medicine and its practices is a very important issue in chiropractic and entertains a long history. Many of D.D.'s earliest advertisements were attacks on medicine and the procedures of medical doctors. The objective straight chiropractor has moved away from this kind of activity in an effort to distance the profession from the idea that chiropractic is a substitute or alternative to medical care. The traditional chiropractor is still very vocal in his attacks and one national organization and its leadership seems to build its entire activity around attacking medical procedures and the medical profession. Is there a place for medical bashing? Does badmouthing the medical profession help us attract people to chiropractic? Certainly there are some people who dislike medical practice enough that they are attracted to anything that is against it, including chiropractic. But there are probably just as many, if not more, who have a degree of respect for medicine and who will be turned off by our attacks and, in the process, disregard the true message of chiropractic.
While medical bashing does not have a place in objective straight chiropractic, I do believe we should compare the ADIO approach to life and health with the outside-in approach. While in a strict sense this is not chiropractic, many chiropractors choose to educate their practice members about the ADIO viewpoint of life because it gives them a better appreciation for chiropractic as well as the ability to handle other matters relating to their life and health. Unfortunately, the clearest examples of these two approaches as they relate to health are chiropractic and medicine. In this respect, a comparison of the philosophies of medicine and chiropractic is not only appropriate but also helpful. However true, I would not suggest that a comparison between ADIO and outside-in be done on the first visit. It is clearly continuing education. Additionally, it should not involve anti-medicine, anti-medical information, be it written, spoken, or implied.
We should be comparing principles, not practices. For example, the fact that chiropractic has no harmful side effects really should not be compared to the many seen with medicine because it relates to practice rather than to principle. While it is true, it is comparing apples with oranges. Restoring good (health) should not have any side effects while fighting disease almost always does (in the military it's called "collateral damage"). All the statistics about people dying or ending up in hospitals as a result of medical care is not relevant to a comparison of approaches. It makes it seem that chiropractic is an alternative. Comparing the education of a chiropractor with a medical doctor or the cost of respective care are non-issues. It would be like comparing the training of and cost of auto repair and plumbing. Again, none of this is relevant because it relates to practice.
What is relevant in comparing the chiropractic approach with the medical approach is anything related to principle. For example, the fact that chiropractic works to restore health can be compared with medicine's attempt to treat disease. That is a relevant issue. The fact that medicine claims to know educatedly what the body needs is another issue. Usurping or trying to usurp the authority for running the body from the innate intelligence could also be discussed. There are a number of issues that could and should be discussed comparing the medical (outside-in) approach with the chiropractic (inside-out) approach. Remember though that these issues and principles are not really about chiropractic and medicine. They are about a way of looking at life. Consequently, the more we stay away from the practice of medicine, the better our presentation of the true issue will be.
Our profession continues to vacillate between attacking the medical establishment and craving acceptance from it. I think both extremes have caused many of our profession's present problems. D.D. wanted acceptance from the community and tried to get it by attacking medicine. In this manner, chiropractic received a certain degree of acceptance but only as a last ditch effort to relieve conditions that medicine could not. Those with no problems and those who thought they were satisfactorily treated by medicine had no use for chiropractic care. In fact, those who were helped by chiropractic usually had no further use for it.
As medicine improved in meeting its disease-treating objective, B.J. pushed for acceptance by the scientific community. His attempts at this were hallmarked by trying to prove that chiropractic was superior to medicine and its methods, by noting that chiropractic addressed the cause and did not have the dangerous side effects of medicine. Unfortunately, B.J. was never able to prove that a body free of nerve interference could heal itself better and faster than one with drugs or surgery, mostly because the chiropractic idea of healing and that of medicine/science are worlds apart. One deals with inside-out (the creation of living tissue), the other with outside-in (the relief of symptoms). After B.J.'s death, his son Dave wanted acceptance by the educational community and he helped put the wheels in motion that have led to many of the problems we now have in chiropractic education.
We attack medicine but we want to be accepted as equal to the medical doctor. We criticize the medical doctor's ability to diagnose and treat disease, knowing full well that our education is not nearly as complete as his is with regard to materia medica. We want government recognition yet we are willing to sue the government based upon the contentions of one person. We brag about how studies have shown that chiropractic is effective for low back pain. We point with pride to this independent research that substantiates our ability to take care of that condition. But we also want to say that we can effectively treat 28 other conditions without a shred of substantiating research. We may phrase our claims in terms like "chiropractors do not treat..." or "we correct the cause" but the message to the public is that chiropractic treats those 28 conditions. We cannot have it both ways. If we are going to use Rand, et al to support our claims for the treatment of low back pain, then we have decided to play in the research/science arena which negates our right to make claims outside that arena. If we are going to prove chiropractic by research, then we must stick to low back pain because that is all we have scientifically proven. If we want to claim chiropractic as an effective treatment for other diseases, then we need to play by the same rules and prove it like we did low back pain and stop making claims until we have that proof. This is the standard by which the treatment of medical conditions is proven. If we disagree with this standard, then we are really questioning the validity of the whole research/scientific system (which is open to criticism). However, if we do reject this system, then we have negated the validity of Rand, et al because that was the method used. We are between a rock and a hard place. If we accept the validity of research, we can only claim low back pain and have to acknowledge that medicine is the only proven effective treatment for the other 28 conditions. If we say that their research is flawed, then we have, in fact, negated the use of it in supporting what we do in terms of low back pain.
The philosophy of chiropractic, in my opinion, is the most honest, forthright, consumer-oriented approach to health that this country has ever seen. For us to produce materials that would cause the government to claim our public education is misleading is a travesty. If we, as a profession, said that we believe chiropractic can cure cancer in two visits, I think the FTC would leave us alone. They may think us crazy (and they would be right) but they would have to respect our first amendment rights. But, if we said or even inferred that scientific studies show that chiropractic can cure cancer in two visits, then they would have every right to come down on us. The government sees that difference. I see that difference. I guess some of our profession does not.
Where does the objective straight chiropractic philosophy begin and end? How can a chiropractor be sure that when he is explaining something to a practice member, he is within the boundaries of straight chiropractic? We have discussed this issue before but since it came up recently on the internet, I thought I would give it a little more thought and some added comment. Straight chiropractic actually is confined to some very limited parameters. Objective straight chiropractic is limited to locating, analyzing and correcting vertebral subluxation so the inborn wisdom of the body can be more fully expressed. However, when it comes to the philosophy that supports that objective, it is not as easy to know what is objective straight chiropractic and what is not. From a practical standpoint, various issues come up, such as the appropriateness of having lending libraries in the office and lifestyle recommendations regarding diet, rest, exercise, and the prevention of vertebral subluxations. A better understanding of the philosophy will better equip us to handle these issues.
First, we must realize that the objective straight chiropractic philosophy is part of a larger philosophy of life, which we in chiropractic call the above-down, inside-out (ADIO) philosophy. Chiropractic is only one small part of that philosophy. In fact, the ADIO philosophy encompasses just about every facet of the human experience. (See the accompanying chart on the following page). It is a thinking process which gives a person a particular perspective of life. Notice the placement of the objective straight chiropractic philosophy, that part of the ADIO philosophy that we apply to what we do. We are not psychologists or sociologists or politicians. Yet while we do not practice any of those professions, there are areas of ADIO thought common both to chiropractic and to them. Taking responsibilities for one's life and actions and not being forced to conform to a national average are just two aspects of the ADIO philosophy that have both chiropractic and social applications. Capitalism encourages individual effort. Socialism does not. We do not attempt to conform people to a physiological average as medicine does. The ADIO philosophy also recognizes that while everything is not black and white, right or wrong, there are absolutes. There are many more examples but I think you get the point.
Notice that chiropractic sits between health and physical or human function. Chiropractic is not truly a health field, although that is where most people place us. Others put us in the human potential movement, although technically we do not belong there either. Chiropractic is unique and therefore occupies its own place in the ADIO philosophy. Certainly it touches upon both health and human function and is more closely aligned to them than it is, to say, law or psychology. But it also has a number of principles and viewpoints in common with all other aspects of the ADIO viewpoint, hence the circle in the center.
With the vastness of the ADIO philosophy, how can we know when we have moved from chiropractic philosophy into the much broader ADIO philosophy? It is relatively easy to know if you are discussing law or politics but the close proximity of health, human potential and certain theological concepts to chiropractic makes the boundaries very fuzzy at times. I am not sure we can always know for certain when we are outside the realm of chiropractic. I know B.J. and D.D. often wandered out of chiropractic philosophy in the strictest sense. Talking about the practice of medicine as we discussed previously in this issue has nothing to do with chiropractic. Comparing medicine's outside-in and chiropractic's ADIO approach is part of the ADIO viewpoint. Is it all right to address ADIO issues outside of chiropractic philosophy? I think that may be an individual decision. If it detracts from your chiropractic objective, you may want to question its value. Offending people with an ADIO viewpoint of theology and politics so that they discontinue care may hinder your objective. There really is a great deal to be learned within the straight chiropractic philosophy. Talking about other areas of ADIO philosophy with which people are familiar, however, may better enable them to understand and accept the chiropractic philosophy. For example, a person with an ADIO viewpoint of politics or economics may better comprehend the chiropractic philosophy of taking responsibility for one's life.
The real key, as I see it, is making sure it is the ADIO philosophy you are discussing. The outside-in viewpoint is so prevalent today that it easily creeps into our thinking. We are all guilty of it. B.J. called it slipping and checking. The issue may not be "is it chiropractic philosophy?" but rather, "is it consistent with chiropractic philosophy?" i.e., is it ADIO philosophy? The beauty of both chiropractic and our ADIO philosophy is that they are in perfect, uncompromising agreement. Whatever subject we are discussing, that logic, that consistent viewpoint, should be uppermost and clearly evident in our discussion.
Why Chiropractic is not an Alternative to Medicine
The philosophical conflict between medicine and chiropractic can be summed up simply:
Medicine believes that disease causes a lack of health.
Chiropractic believes that a lack of health causes disease.
Consequently, medicine treats disease while chiropractic addresses one of the causes for a lack of health.
Medicine and chiropractic are going in opposite directions.
An alternative is a different way of achieving the same objective or going the same direction. Hence, chiropractic cannot be an alternative to medicine.