Prince Charles
In 1997, a steering committee for the "Prince of Wales's Initiative on Integrated Medicine" published a 68-page discussion document. The report makes several points which are important to this series of articles:
- A patient's right to choose must be preserved.
- The subject of "biological plausibility" needs to be addressed.
- It would be preferable if alternative and complementary practitioners came under the same umbrella.
The authors pointed out that #3 was not likely to occur, as various groups tend to fight for their own turf. The authors therefore recommended:
- A core curriculum should be developed for all practitioners.
It's important to note that Prince Charles' committee used the term "integrated medicine," a concept deserving extended comment. But this not the time or place for that. Caution is called for with respect to the idea of "integration."
An excellent book on the health care situation in England, Complementary Medicine and the Law, makes an essential point. "Integration" is simply a euphemism for "colonization" by the allopathic community of all successful therapies. I suggest we should seek equality before even considering integration.
A patient's right to choose is an illusion unless there are providers authorized by law to render the type of service chosen. It may surprise you to know that in the U.S. a mother has the constitutional right to abort her fetus; that Dr. Kevorkian is shown on television giving lethal injections to his patient; and yet there is no generally recognized constitutional right to choose alternative care.
No case raising issues of a chiropractor's scope of practice should ever again be brought without also speaking of the patient's right to choose.
Biological Plausibility
In early December, 1998, I saw Peter Jennings on "Larry King Live" discussing his book about the major events and persons of the 20th century. He commented that the Scopes trial (the right of a teacher to teach evolution) was a turning point in this century. His point is well made. The issue of materialistic evolution, and the additional philosophical idea that reality (or disease) can be fully understood by looking at separate parts, remain at the center of all questions related to biological plausibility. Volumes have been written about these issues. I will limit myself here to just two points.
"Vitalism" and "holistic" thinking were declared to be nonsense by the early 20th century philosophers of the Vienna circle (such as Bertrand Russell) starting in the 1910s. Their position was, in significant part, prompted by Darwin's ideas. All practitioners, such as D.D. Palmer, who have refused to go along with this viewpoint were and still are branded as "quacks."
This perspective on "quackery" is evident in a journal established in 1997: The Scientific Review of Alternative Medicine. A brief review of this publication makes it immediately obvious that by "scientific" they mean only scientific materialism. The founders of that publication have no room for ideas such as morphogenetic fields, energy or information medicine. Mind and/or "universal/innate intelligence" are totally taboo.
The following two articles from Volume 1, No. 1 of the Scientific Review of Alternative Medicine (fall/winter, 1997) manifest the philosophical bias of the publication:
1) "Is Homeopathy 'New Science' or 'New Age'?"
Which do you think they chose? One should look at a book by two Italian MDs for a counterpoint: "Homeopathy, a Frontier in Medical Science." These MDs make a convincing argument that homeopathy may, among other things, be working at the level of "information," probably having to do in part with the H-O-H bonds.
2) "Quantum Metaphysics"
This article merely reiterates the materialistic and reductionistic philosophical presuppositions of its author, Victor Stenger, who is also the author of Not By Design: The Origin of the Universe.
Let's go one step further and look at some of the persons on this journal's "council for scientific medicine." (Only 23% of the people listed as members of this group are MDs). Two names should ring a bell with all who followed the Wilk case. I am referring to the "quackbusters" William Jarvis and Stephen Barrett. Enough said!
The philosophical bias of two other members of this group will suffice to make my point: Sir Francis Crick (co-discoverer of the DNA molecule), and Anthony Flew.
Sir Francis Crick has been called by one author a typical "English anti-clerical curmudgeon." Sir Francis argued in his recent book, The Amazing Hypothesis, that "mind" is totally explicable by brain chemistry. Really, he just asserted his "faith" that we will some day be able to explain it all by chemistry.
Anthony Flew is one of the world's leading atheistic philosophers. One of his main claims to fame is his book, The Presumption of Atheism.
The viewpoints of Crick and Flew deserve constitutional protection, as does those of us who disagree with their philosophical presuppositions.
In my opinion, the circumstantial evidence for Darwinian evolution (as an explanation for the development of complexity and varied life forms) is outweighed by the evidence for life being the product of intelligent design. I mean, life is a meaningful, purposeful (teleological) unfolding. (A more inspiring way of expressing this thought is captured in Rabbi David Cooper's book God is a Verb.)
The subject of "biological plausibility" demands philosophical openness, scientific commitment and full and open debate. Of course, it is absolutely essential to recognize where philosophy ends and science begins.
Core Curriculum
At the start of the 20th century, the medical field had many different types of practitioners. The MDs were called "regulars" and the rest were called sectarian. The regulars were allopaths who, like all other practitioners, have a particular philosophico-medical model which directs their thinking. Many of the so-called sectarian practitioners were given legal protection in the early part of this century. For example, California in 1907 created a medical board composed of five allopaths, two homeopaths, two eclectics and two osteopaths.
The story of how the allopaths became the dominant force at the expense of the homeopaths, et al., is beyond the scope of this series of articles, but I recommend that anybody interested in the subject at least read: E. Richard Brown's Rockefeller Medicine Men (the powerful group behind the Flexner report); Vols. 3 and 4 of Harris Coulter's monumental work on the history of medicine, Divided Legacy; and The Social Transformation of American Medicine by Paul Starr.
The general attitude towards licensing in the early part of the 20th century was to grant a license to anybody certified by the associations of the respective groups. However, pressure was developing for the states to require completion of a core curriculum. Many practitioners argued that it would be unconstitutional to impose such a curriculum.
The core curriculum issue was obviously heading for the United States Supreme Court. It got there in the 1912 case of Collins v. Texas 223 U.S. 288. The Supreme Court ruled that a state could, in effect, impose a core curriculum on all persons seeking to be licensed to practice medicine in any of its branches. California and many other states, including Illinois (see Part III), responded by establishing two basic core curricula and two basic license categories:
- physicians and surgeons;
- drugless physicians (or sometimes drugless practitioners).
Licensure of physicians and surgeons was, as has been repeatedly stated by the state and federal courts, designed to allow persons to practice medicine in all its branches, that is, without express limitation. The drugless practitioner category was designed to include the eclectics ("mixers"); homeopaths; naturopaths; osteopaths; chiropractors and all other types of practitioners, as long as they met the requirements of the core curriculum. I will return to these issues more specifically in Part III, but it is essential to presently recognize that the category "drugless physician" is broader, and more inclusive, than any of the specific categories such as naturopaths, chiropractors, etc. The drugless category was the umbrella title under which all such practitioners once practiced. We can again.
It is also imperative to recognize that although the scope of practice granted under the licensure of physicians and surgeons granted allopaths (and presently osteopaths) the power to practice medicine "in all its branches," they have failed to fulfill their franchise. This point was demonstrated in a 1997 release from the Association of American Medical Colleges. It clearly states that "conventional Western medicine" is allopathy and that allopathy means treatment designed to "oppose disease." Fine, as far as it goes, but we also need to remove interference with the body's innate regulatory system(s) and support host resistance, etc.
Of course conventional medicine does quite frequently go beyond treatment by "opposites". A good recent example is the spinal cord regeneration stimulation techniques being used with Christopher Reeve. We should pay particular attention to the fact, however, that the doctors who are treating Mr. Reeve do not run out and seek a new license category. We need to follow their example and bring the various types of alternative practice under one drugless umbrella.
Before we can obtain legal recognition for such an umbrella, we will need to compare allopathic and chiropractic education and then ascertain what in addition to manipulation needs to be added to an expanded core curriculum to make one a drugless physician. Obviously, in developing such a curriculum, it would be necessary to address at least: herbs; acupuncture; homeopathics; bioenergetic and biofunctional medicine; detoxification; and such things as the "biology of belief," and perhaps additional training in clinical nutrition.
Appropriate medical model(s) or theories are also essential. Of course many factors will need to be considered in developing such a program: the law in the various states and, in particular, and by way of example, the legal opportunity for up to 720 hours of electives within the chiropractic core curriculum required by California statute.
There is an excellent article comparing chiropractic and allopathic education in the September 1998 issue of the peer reviewed journal Alternative Therapies. The article is generally favorable to chiropractic education and points to the fact that DCs have more hours than MDs in certain of the basic and clinical sciences, and also in such areas as nutrition.
For my purposes, I will look to the legal requirements related to chiropractic and allopathic education and will use California as my example. (Illinois is perhaps an even better example and I will look at that further in Part III.) It should be noted that allopathic and osteopathic education is essentially the same except that the osteopaths add more natural healing methods and also manipulative therapy.
By statute, California chiropractors and medical students (allopaths and osteopaths) are each required to complete 4,000 hours of education. This has been increased under accreditation standards to approximately 4,800 hours for each group. However, medical students must complete their clinical studies in a hospital setting and must complete a one-year postgraduate hospital program in addition to the 4,800 hours. (In addition, residency training is required by private associations participating in the process for granting specialization status.)
The medical establishment is likely to argue that hospitalized education is superior to training in an ambulatory setting. It is, at least in part. But it is also a significant negative side. Hospitalized patients are obviously already a long way down the disease continuum. The allopathic focus on the disease state thus becomes detrimentally reinforced. There is a great need to also recognize, train for, and focus upon:
- prevention and early intervention;
- removing interference with and maximizing the function of the body's innate ("holistic") regulatory system and host resistance; and
- the diagnosis and treatment of disease by all means necessary short of the use of allopathic drugs or operative surgery.
"Holism" and the proposition that life is the product of intelligent design each have important social and cultural ramifications. It will not suffice for those of us who accept such ideas (or the contrary for that matter) to articulate them within only our own group.
We need to consider the social and cultural consequences of our basic assumptions and avail ourselves of all available opportunities to express our position in the market place of ideas. Mainstream medicine does this all the time. One example will demonstrate the point. The subject of euthanasia has been a subject of deep philosophical debate in the western world for millennia. It was recently addressed by the United States Supreme Court in the cases of Washington V. Glucksberg and Vacco v. Quill. Fifty-two friends of the court briefs were filed in the Washington case alone. "Everybody," from the AMA and the AMA Student's Association to the National Association of Prolife Nurses, and even an individual practitioner of alternative medicine (Julian Whitaker), raised their voices and filed briefs. Unfortunately, no chiropractic organization or philosopher presented their ideas to the court.
In Part III, I will make specific suggestions as to how a postgraduate program for the drugless physician could be made a reality under the law. The suggested course of action may also help to resolve the conflicts within the chiropractic community as to "what chiropractic really is," and also the potential conflicts between chiropractors and other practice groups, such as the naturopaths, etc.