Today I received a "chiropractic publication." On the front page was a follow up article on "The 'Growing Pains' Sitcom Incident." For anyone who has been underground for the past four months, it seems Alan Thicke, the father in the show, was lecturing his son on honesty and told the boy that if he did not stop lying he would probably grow up to be a chiropractor. It seems that Alan Thicke's father is an M.D. and his sister a chiropractor. What is apparent now that the furor has passed is that this was not part of an AMA plot to discredit chiropractic. The producers, directors, and actors of the show do not have an ax to grind against chiropractic. No one was intentionally trying to belittle our profession. It was simply a joke that was not funny to a certain segment of the public. But then neither are most ethnic jokes. The problem occurred when we got bent out of shape, started letter writing campaigns to networks, sponsors, and everyone else involved, made them edit the joke out for syndication, and demanded an apology. When the apology came, we were not satisfied. In fact, this publication indicated that we still were not satisfied and were working on the situation. Frankly, as a profession, I think we acted a bit childishly. When I first heard the remark, I simply cringed a bit. It was no big deal. If the remark had been made substituting "dishonest plumber" do you think the American Plumbers Association would have started a letter-writing campaign? A remark like that must be taken in the context in which it was said. It is, after all, a comedy show. Most people probably thought it was funny. (If the writers had used lawyers instead, I would have thought it was funny.) I cringe when I see a comic strip with a person bent over on his way to a chiropractor because, to me, chiropractic is not for bad backs. Most of our profession probably think that is great for P.R.. In the same issue (page three) was a full-page article "Is There a Doctor in the Journal." It referred to a Wall Street Journal article on Palmer vs. Life Rugby and how the writer of that article kept referring to the chiropractors involved with the two schools as "Mr." rather than "Dr." The inference was that the W.S.J. is controlled by medics who will not give chiropractors the rightful title "Doctor." Come on, gang, aren't we being a little childish? On page 27 of the same issue, almost an entire page is devoted to blasting a chiropractor who is selling a book teaching the public to give adjustments. Do you see a common thread throughout these unrelated incidents? We have a profession that has such low self-esteem, such an inferiority complex and is suffering from such paranoia that we believe the entire world is out there trying to destroy us, steal what we have, or both! Children get upset when other children call them names at play, adults don't. Chiropractors who are secure in their profession don't fall apart when someone purposely maligns chiropractic in general or inadvertently forgets their status. Chiropractors who know they have a unique service that no one else can offer are not afraid that someone is going to steal it. It is apparent that many in our profession have such low self-esteem that they must scream and kick when they feel they are being ridiculed. They have such little regard for what they do that they believe a do-it-yourself book can replace them. After almost one hundred years it is about time we grew up and started acting like an adult profession. We should be secure enough that we would not allow little attacks, purposeful or inadvertent, to throw us into a tantrum.
WHY THE SOUTH LOST THE CIVIL WAR
I recently read a book with the above title. It presented some interesting theories and ideas concerning the Great Conflict that tore apart our nation 125 years ago. As I read the book I saw interesting analogies to the internal conflict that our profession has been experiencing for the past sixty years. The straight-mixing conflict has heated up considerably over the past ten years. Although there are some indications that it is lessening, in other areas it appears to be just as violent as ever. Some of the principles outlined in Why the South Lost the Civil War could be valuable to us in understanding our professional strife and being able to better handle it. Most people think that the South lost because the North had more men, more money, more guns, and the advantage of the industrial complex over the South's basically agrarian society. While all these are true, the authors contend that it was not so much that the North won, but that the South lost! The loss of the War was largely the lack of the southern leadership's ability to effectively wage war. The authors of the book argue the reasons but they generally agree on the cause of the loss, that is, the lack of a will to win. "The Confederate leadership had little concept of mobilizing civilian opinion. Instead, it depended on military success to sustain the public will to attain victory. The South sought to build up the morale by focusing on the defeat of the enemy rather than the principle upon which they fought." When victory didn't come, when battles were lost, morale sagged, creating losses, thus setting up a cycle. Confederate leadership always had to keep in mind that a Confederate victory perceived as a loss by the public (perhaps because of great casualties) was indeed a loss because it further eroded the will to win. The legislative, political, and judicial losses that the straight movement has experienced over the last ten years have had an eroding effect on the movement especially in terms of the financial cost. The anti-trust suits which were started largely as a morale booster have had an opposite effect. To many in the War between the States (on both sides of the Mason Dixon line) the War was a holy war. Emery M. Thomas says "Southerners believed themselves the last best hope of western civilization." Lincoln believed that the Union embodied the last hope for mankind. To many straights (and some mixers) the straight-mixing conflict is as much a holy war as the Civil War in which both sides thought that God was on their side because they believed themselves to be right. Many in the South believed God had abandoned them as they lost battles. Similarly, many of the straights have lost faith in the "cause" as the legislature and courts, while far from being God, have adjucated against them. Karl Van Clusewitz, one of history's greatest minds on the subject of war said, "the smaller the penalty you demand from your opponent, the less you can expect him to deny it (victory) to you." Stamp proposes the hypothesis that many Confederates lacked a deep commitment to the cause and that unconsciously "the behavior of some suggested that a Union victory was quite an acceptable result." Bearing in mind the statements of these two men, what does each side in the "chiropractic civil war" have to gain or lose? The mixers see their way of life being destroyed if the straights succeed. Laws such as in Washington state, Georgia, and Michigan have altered the way a mixer can practice. Second, many of them have felt the economic effects of large volume, straight practices in their community, i.e., loss of patients. Third, they see a loss of their status as a physician and fear even worse, that the balance of powers would go into the hands of the straight as more of them enter practice. The straight, on the other hand, sees no loss of his way of life. No mixing law or broadening of a state law has ever forced any straight to change his manner of practice. Not yet! Who has the most to lose? A straight isn't bothered by a dozen mixers opening up around him. Clearly the mixer is going to make it a holy war. The South, at worst, lost the practice of slavery which only affected a small percentage. Eventually they went back to the status quo. The North saw the dissolution of the union as destroying the United States. Many in the straight movement would be satisfied to return to the status quo of chiropractic which existed twenty years ago, at least with regard to the straight-mixing issue. They feel a loss in this battle would mean only that. But the South found out after the War that things, are never as they were before. There is another interesting analogy. David Potter points out that the "one party system" of the South helped lead to its downfall. In contrast, the North with its radical republicans and the democratic party, who fully expected to defeat Lincoln for re-election, provided an avenue for dissent. In chiropractic, we have a "two-party system" for the mixers: those who diagnose and adjust, and those who do everything under the sun. Actually, there is also a third group: those who give lip-service to diagnosis and only adjust. While these groups have differences, the ability to have and express differences, ironically enough, keeps them together. The straights, on the other hand, leave no room for dissent. I am not suggesting that they should or should not. This fact of life, however, creates major defections or at least a non-supportive attitude among many straights. There are many straights who are non-supportive of the straight movement because of the personalities of the leadership and because of the techniques espoused by those in leadership positions. The political organization of the straight movement leaves very little room for differences of thought. It is made up of a rather close-knit, relatively small group. It is barely a dozen or so people who wear different hats within the straight organizations. This is not meant to be a criticism. They are by and large a selfless and dedicated group. However, the singleness of mind in the straight movement gives chiropractors the impression that if they do not practice exactly as the leadership does, they are not wanted and are included in "the enemy." This impairs the effectiveness of the movement. The Southern will to win was no doubt further eroded by economic factors. Soldiers for the Confederacy deserted when they realized their families back home were starving without them to run the farms. It is surprising, given the hardships that the civilians of the South suffered, that more did not simply walk away from the War. The economic factor is also affecting the straight chiropractor. However, this time it is not a matter of starving but of attaining wealth. Many have deserted the straight ranks for the get-rich-quick schemes of some of the mixer element. This depletes the straight movement. But, what is worse is that it demoralizes, many straights in positions of leadership. The sacrifices of time and money that they make for the cause are great and made greater when they see their friends and former college classmates literally making millions. This particular problem is evident in the straight chiropractic college. Very few are willing to make the sacrifice of teaching, especially when they see their former students mixing. The straight chiropractor begins to wonder whether the issue of principle is really worth it when even those that should be standing shoulder to shoulder with them have deserted the ranks and by their manner of practice, for all intents and purposes are giving aid and comfort to the "enemy." When General Braxton Bragg marched into Kentucky with the hope of "freeing" the inhabitants of Yankee control and raising recruits for the Confederate cause he was met by virtually no support. Kerby Smith, Bragg's Adjutant, told General Cooper that "the love of ease and fear of pecuniary loss are the fruitful sources of this evil." Simply stated: Support for the Confederate cause was grossly inadequate and much less than the leadership of the South had anticipated. Consequently, the bulk of the war effort fell to a few. There are numerous other interesting analogies to problems of the southern war effort. Southerners were disenchanted with the totalitarian views of Jefferson Davis. He was not a very likable personality. Straight chiropractic's hard line and the personalities who are strong and somewhat abrasive tend to create disenchantment. In the South there was a basic philosophical/practical problem, that is, the confrontation between faith and reality. Could states rights work? It was the major issue in secession yet many found they had merely exchanged an oppressive government (in Washington) for another (in Richmond). Straight chiropractors take a position on medicine and medical procedures. Then they find that in practice many of their patients seem to need therapeutic or medical procedures. This creates a problem that only a strong understanding of the philosophy can resolve and frankly many do no have that strong understanding. To many in chiropractic the philosophy is not a reality. The issue of states rights and slavery brings up another analogy. Some authorities believe that the Confederacy functioned as a nation only in a technical, organizational sense and not in a spiritual sense. They lack a oneness or a concession on why they fought. For example, there arose dissension when it was proposed that slaves be pressed into military service and in return given their freedom. Those fighting for slavery said that slavery was the issue. Those fighting for states rights said if they did not use slaves they would lose the war and have nothing. There was dissension in the South and apparently a lack of agreement as to what the war was really all about. Perhaps with the straight movement there is confusion as to what we really want from this war that has raged for six decades or more. One last point in this rather lengthy "book report." On page 80 of the book the authors state "Southerners did not really want a separate destiny, but rather wanted recognition of the merits of southern society and security for the slave system." When the price of the above became too great they abandoned the Cause. If their goals were great enough they could have extended the war for years in the mountains and eventually wore down the North. The Vietnamese were able to do it to a much stronger Union, 100 years later. The South surrendered because they lacked the will to continue the fight. Is there sufficient will and desire among the straights to develop a separate and distinct profession from mixing chiropractic? "The Confederate nation was created on paper, not in the hearts and minds of its citizens." Unless straight chiropractic is in the hearts and minds of its citizens it will meet the same ending as the Confederacy. As one of the authors said, the Confederacy's tombstone should read, "Dead of Failure of the Will." Can the same malady befall us? Is it already upon us?
CHIROPRACTIC LICENSE MILLS
Not too long ago the medical profession criticized the numerous chiropractic schools around the country saying they were nothing more than diploma mills. Of course their viewpoint was less than objective. Apparently, however, the profession must have felt that the public perceived many schools in this light, for until the mid-seventies chiropractic schools were dwindling in number. Recently a change has been noticed in chiropractic education. The curriculum in the schools is slowly evolving toward the primary objective of equipping students to pass state and national boards. At first glance this might not seem like such a bad idea. After all, the boards are invented to be a test of the graduate's ability to practice chiropractic. However, in reality the vast majority of knowledge tested on state and national boards bears very little relationship to the day-to-day practice of chiropractic. Conversely, very little testing is done that actually determines a chiropractor's competency and proficiency in day-to-day practice. The chiropractic colleges, by the nature of their curriculum and their emphasis, have a short range objective, that is, to enable the student to "pass the boards." That is not how the system was intended to function, but that's, in fact, how it does. Students become more concerned about their academic subjects (those they will not use in practice) than they are about those subjects that will be a part of their daily practice, i.e., technique, philosophy, and clinical experience. In addition to worrying over their academic subjects while in school, they spend great sums of money to take courses to help them pass the boards. We can see, then, why technique courses on the post-graduate level are extremely popular. A chiropractic college graduate may spend great sums of money taking a week-end course in order to learn technique and chiropractic related subjects which he should have learned during his four academic years. The obvious reason is that he did not learn technique because he was too busy studying to "pass the boards."
There are just so many hours in a chiropractic course of education. The more competitive the examinations become, the more emphasis the schools must put on preparing the student to pass them. The more emphasis on passing the exams, which, as we said, are largely academic, the less emphasis on chiropractic subject matter. The greater emphasis on preparing the student for his clinical experience, the less students pass the board examinations. The state and national boards, with very few exceptions, do not view the purpose of chiropractic education as preparation for practice, but rather as preparation to pass their exams. The problem will inevitably get worse. The exams aren't getting any easier. They are, in fact, becoming more difficult. The number or hours of the course of chiropractic education has increased very little. Something has to give. The student is not dumb. He knows that he can always learn to adjust, learn to analyze an X-ray, learn office procedure, patient education and whatever else is necessary to be a competent, successful chiropractor after he gets a license. He will spend his time and effort on biochemistry, pathology, and diagnosis and be satisfied to just get by in technique, philosophy, and clinical experience. Is that what we are trying to accomplish in chiropractic education? I think not. Obviously the solution has to begin from above, that is, with the boards. The schools are forced to make their program reflect what the exams require. Graduating chiropractors, however competent, who cannot pass a state board, does not attract students. Those making the examinations must begin to make them relevant to the practice of chiropractic. Anyone can make a difficult test. Making a relevant one that tests useful knowledge and competency takes much more effort. Unless that is done one of the following will occur: 1. The schools will have to lengthen the program to adequately prepare students to pass the boards and teach them chiropractic. This would make a chiropractic education longer than a medical education and would make chiropractic less attractive as a career. 2. Less and less chiropractic will be taught until chiropractic procedures are taught strictly on the post-graduate level or as an elective. This is what happened to osteopathy. Perhaps the time has come to question the need for state board examinations. They came about when chiropractic (and medical) schools were proprietary institutions. The schools were designed to make someone a profit. As a result, short easy programs were developed to attract less than competent students. That has changed. There are no longer proprietary schools. Regional and specialized accrediting agencies are designed to insure the competency of the chiropractic program. In addition, the state boards have become a political football over which opposing factions fight for control. It was never intended as such. Those that are on state boards are usually not educators and have very little knowledge of testing procedures. Can we do away with state board examinations? The possibility should be investigated. Unless we do, chiropractic colleges will increasingly become just "license mills" rather than educational institutions.
