Dear Editor:
The October 13, 1992 issue of Dynamic Chiropractic carried several responses to Dr. Dana Miller's September 1, 1992 article, "It's Time for a Divorce." Dr.
Dr. Dutson of San Point, Idaho would have us reinvent the wheel his way, breaking the profession into SC and DC types. He believes that such separation would allow each group to grow. He failed to recognize that we already have well established liberal and conservative organizations. It has done nothing for the "present distractions and back biting," he states.
Dr. Mike Phillips of Carlsbad, California correctly points out that there is a mainstream and some extremes in our profession. He sees good in both. He doesn't mention what's good. He's obviously a politician. Why he doesn't belong to the California Chiropractic Association bothers me some. Must be they're either too good or too bad for him.
It is truly a moving experience to read the diverse comments inspired by Dr. Miller's article, "It's Time for a Divorce." Each of these well-intentioned chiropractors, along with Dr. Miller are generous in defining our problems. Their solutions are so simple that one is moved to wonder why we have problems at all.
The profession at large can be reassured. None of these articulate colleagues are members of either ACA or ICA. They obviously feel that their ideas are more valuable than their memberships. If only the people trying to lead the profession had the benefit of such wise counsel. Give us more, brothers, it sounds sooooo good.
It's very clear what these articulate, well-intentioned, but obviously selfish and shortsighted DCs want. In plain country English -- nuthin'. They ain't paying nuthin', they ain't doing nuthin', and they don't deserve nuthin'.
Talk's cheap friends. Start carrying water before you try to manage the farm.
John H. Gantner, D.C.
Medina, New York
Beyond Musculoskeletal
Dear Editor:
You are right. "Chiropractic is much more than musculoskeletal." (Editor's note: This is in reference to "The Big Picture" in Nov. 6th issue.) And because we believe this to be true, FCER is focusing much more on funding research which holds the promise of demonstrating chiropractic's efficacy in treating somatovisceral and other internal disorders.
For instance, FCER is currently funding two headache trials at Northwestern College of Chiropractic. The first which compares chiropractic treatment with pharmaceutical interventions, is complete and will soon be submitted for publication. The second is just getting under way. Results of the first clinical trial look very positive for chiropractic.
FCER now has before it one of the most exciting and well conceived studies ever submitted for funding, "Chiropractic and Primary Dysmenorrhea: Proposal for a Full Randomized Clinical Trial: Hormone Determination and Manipulative Force Guidelines." The proposal, submitted by Dr. Patricia Brennan and her colleagues at the National College of Chiropractic, addresses the effect of spinal manipulation on pain and prostaglandin levels in women with primary dysmenorrhea, a condition affecting more than half of the women of childbearing age. A highly encouraging pilot study was recently published in the Journal of Manipulative and Physiological Therapeutics, 15:279-185, 1992. Everything points to the need for a larger clinical trial to clearly demonstrate chiropractic's efficacy in the treatment of this condition.
If FCER succeeds in raising the necessary funds to launch this clinical trial, the profession can look forward to the following:
- The trial should pave the way for the effective and safe treatment of patients suffering from primary dysmenorrhea by helping to define practice parameters.
- The trial will provide an alternative to drug therapies, which have proven ineffective in up to 30 percent of all cases and which frequently have deleterious side effects.
- The trial will also allow for a quantitatively measured comparison between effective chiropractic and sham manipulations.
- It is also expected to confirm that chiropractic spinal manipulation lowers prostaglandin levels, thereby demonstrating the potential to mimic drug therapies without the untoward side effects.
FCER's Director of Research, Dr. Tony Rosner, has said that this is "one of the very first studies to provide a biochemical outcome measurement in a randomized clinical trial in chiropractic research. By offering this new yardstick, it frees chiropractic research from being confined to more subjective psychometric indices which may have discouraged collaborations with workers in other health care disciplines."
We expect to soon receive at least two other well-conceived proposals to fund other studies on chiropractic treatment of internal conditions. One study will evaluate chiropractic's efficacy in treating PMS and the other will be concerned with the treatment of infant colic.
Clearly all of these studies are vital to chiropractic's future. The only hurdle to funding them all is money. Since the federal government is not particularly concerned with dysmenorrhea, PMS or infant colic, and large private foundations are, for the most part, dominated by MDs, support for these and other studies which offer the potential of substantiating a broader scope of practice must come from the chiropractic profession and the companies that earn their living from it. Let's hope they care enough to help us get these studies under way. Chiropractic's future depends upon it.
Stephen R. Seater, C.A.E.
Executive Director
Foundation for Chiropractic
Education and Research
Throwing down the Gauntlet
Compliments to you and the staff of "DC" for the treasure you regularly send to all of us in the field. To my knowledge, you were the first chiropractic publishers with sufficient courage of conviction to bravely and repeatedly defy the keepers of our spurious sacred cows.
When B.J. Palmer and the pack of mountebanks that flocked around him, back in the formative years of chiropractic's history, established the horrible precedent of claiming certain scientific knowledge about chiropractic, without first going to the trouble of substantiating their claims, most of us stayed sheepishly silent.
To our lasting shame, that precedent became tradition with us, so that, until recently, any Tom, Dick, and Helen, with sufficient bluster and self-serving drive, could foist new "techniques" on us, while blithely ignoring all conventions of proof, and with more or less complete impunity.
But now, what a pleasure it is to see all of that changing. Dr. Marion McGregor's brilliant challenge to Dr. Lowell Ward, in the September 25th issue of "DC," made my heart sing. I have no doubt whatever, that Dr. Ward has worked very long and very hard in developing his theories. But, however hardworking, however sincere he might be, Dr. Ward and all of the Dr. Wards in chiropractic, are being thrown the gauntlet. Let them beware, lest they be called to answer.
Thomas Linsday, D.C.
Prato, Italy
Not a Question of "What," but "Why"
I read Dr. Keating's article, "It Works for Bed-wetting?" in the November 20, 1992 issue of Dynamic Chiropractic, with interest. While I do not take issue with anything Dr. Keating said, it brings home to me a pet gripe I have regarding what is perceived as the practice of chiropractic, both by those inside and outside of the profession. For too long chiropractic has been defined as the adjusting of vertebral subluxations. I know Dr. Keating knows better, so my criticism is not directed towards him. It is directed towards those chiropractors who have failed to get the big idea.
D.D. Palmer, the father of the chiropractic profession, wrote: "...disease may be caused by injuries or poisons or from the mind. Palmer, 1910a. Along similar lines he also wrote: "... The determining causes of disease are traumatism, poison, and auto-suggestion." His basic model of health and disease was essentially based on life processes, primarily neurophysiological, and not on a biological science of cells as the biomedical model. While manual techniques were a central factor in his health care model, he did not preclude other factors such as nutrition, sanitation, rest, exercise, or even other areas of the body besides the spine.
This big idea is ideally represented in the 1988 Dorland Medical Dictionary where chiropractic is defined as: "A science of applied neurophysiologic diagnosis based on the theory that health and disease are life processes related to the function of the nervous system: irritation of the nervous system by mechanical, chemical or psychic factors is the cause of diseases; restoration, and maintenance of health depend upon normal function of the nervous system. Diagnosis is the identification of these noxious irritants and treatment is their removal by the most conservative method."
The question to really ask concerning bed-wetting or nocturnal enuresis is not if adjustments work (although that is important to address), but what neurophysiological approach that chiropractors have available is more ideally suited for what type of patient? Notice that Dorland's definition does not mention either subluxations or adjusting. D.D. Palmer thought that injuries, biochemicals, and the mind and emotions could cause disease. He thought the physiological mechanism that allowed this to happen was the subluxation. The subluxation in turn caused dysfunction and ultimately disease. Chiropractors now know that while injury, biochemicals, and the mind do, in fact, cause disease, the mechanism is not always through the subluxation. It is, however, often through the nervous system. D.D. Palmer believed in his theory based on the available information he had at that time. He did not cling blindly to his theory as some chiropractors do today. I am not suggesting that we abandon adjusting or our interest in subluxations; I am suggesting that we broaden our vision.
There are several natural approaches that the chiropractic physician may take in the management of enuresis. Small functional bladder capacity (FBC) is a common reason given for enuresis. There is evidence that children with enuresis have smaller FBCs than usual (Stanfield and Mellitis, 1968). It may be one component of developmental delay and suggests inadequate cortical inhibition over afferent bladder stimuli. Some children become dry when their FBCs are increased through "urine holding" exercises or techniques.
Other natural approaches can include a more neurophysiologic explanation. For example, both parents and researchers report difficulty in awakening children with enuresis. The arousal threshold may be abnormally high for many enuretic children (Finley, 1971), perhaps unresponsive to interoceptive stimuli, e.g., from a distended bladder with detrusor muscle contraction (Diperri and Meduri, 1972). Other methods besides adjusting can include learning paradigms involving both classical and respondent conditioning (Lovibond and Coote, 1970).
The point I am trying to make is that while chiropractors have a particular emphasis in manual medicine, chiropractic care as holistic care is more broadly based even if it remains centered in neurophysiology. Chiropractic care is not just subluxation adjusting. The stress on subluxations/adjustments has slowly moved the profession from a natural holistic health care profession that is an alternative to medicine, to a limited musculoskeletal profession. The emphasis should be on Palmer's determining causes of disease and neurophysiological function. Instead of arguing over what a chiropractor can or cannot do, we should be concerned over why he or she does it. Can spinal adjusting relieve bed-wetting? While important to know, it's not as important as knowing if chiropractors can relieve bed-wetting.
References
DiPerri R, Meduri M: Nocturnal enuresis: Further principles of instrumental diagnosis. Acta Neurologica Napoli, 27(1):22-27, 1972.
Finley WW: An EEG study of the sleep of enuretics at three age levels. Clinical Encephalography, 2:35-39, 1971.
Palmer DD: The Chiropractor's Adjuster. Portland Printing House Co., pp 329, 1910a, pp 359, 1910b.
Starfield B, Mellitis ED: Increase in functional bladder capacity and improvement in enuresis. Journal of Pediatrics, 74(2):483,487, 1968.
Edward Charles Sullivan, M.A., D.C., Ph.D.
Mt. Vernon, Washington
"Extreme Views"
Dear Editor:
I read with much apprehension the radical comments of Drs. Barge and Winterstein regarding chiropractic and the subluxation. Why place so much emphasis on such extreme views? Collectively, they may represent two to four percent of the profession.
Hasn't chiropractic suffered enough from such irresponsible philosophical and scientific prejudice? Isn't it time that such radicals be required to document their fringe positions? What about the 96-98 percent of the profession which do not vacillate to such extremes? Shouldn't we be represented in such discussions?
Dr. Barge represents so-called "Old Time Philosophy," scientifically weak, pseudochiropractic. Dr. Winterstein and the National College publication, the polar extreme, an emotional quasiscientific "backlash." Life's experiences teach us that truth usually lies between, rather than at the extreme outlands. Can the truths of scientifically and philosophically rational chiropractic be an exception to universal law?
Chiropractic's goal is to preserve and adhere to truth, both philosophical and scientific. This is possible because true philosophy and true science are one and the same. Drs. Barge and Winterstein prejudices have blinded them. They have wandered so far from reality that they appear incapable of comprehending rational chiropractic. They, therefore, do much harm to the homeostatic balance of mainstream chiropractic science and philosophy.
It's no wonder that the philosophical, scientific and academic communities at large struggle with chiropractic. Each time they approach the philosophical and scientific reality of chiropractic, they are scared off by these irresponsible extremists.
C.C. Wilcher, D.C.
Boise, Idaho
"New World Order"
Dear Editor:
I feel compelled to respond to the comments made by Dr. Barge in the November 6, 1992 issue of "DC," in which he criticized Dr. Winterstein and National College for renouncing the bone out of place subluxation theory, abandoning line drawing x-ray analysis, and using the terms "spinal manipulative therapy" and "adjustment" interchangeably. He asks "after philosophical constructs -- what do we have left?" Well, Dr. Barge, what we have left is the emergence of a democratic movement in chiropractic where the majority rules, and dogmatic dictators are ousted from power.
Dr. Winterstein is not a lone voice when he makes these statements. Many of the chiropractic techniques practiced today no longer subscribe to the "bone out of place" and "hard bone on soft nerve" theories of spinal subluxation. SOT, AK, Nimmo, Cox, Activator, Motion Palpation, and other techniques have developed alternate theories about the subluxation complex and nerve interference, which are very different from Dr. Barge's model of spinal subluxation. Just because someone offers a different model of subluxation does not mean that they are throwing out or completely reconstructing chiropractic philosophy. What an overreaction to change.
When D.D. Palmer first founded this great profession with his theory of spinal subluxation and nerve pressure, he knew that chiropractic would inevitably have to change with time, for in The Science of Chiropractic he wrote:
"... this volume does not contain all that is or can be known concerning chiropractic. There are still many problems for which it will be the province of this comprehensive science to furnish solutions."A theory is defined as a reasoned explanation of the manner in which something occurs, but lacking absolute proof. When a theory is absolutely proven correct, it then becomes a law or principle. Dr. Barge incorrectly assumes that the original Palmer model of bone out of place subluxation is a proven law, when in reality it is an unproven theory.
All theories are subject to change and modification until they are proven or disproven, including our theories about subluxation. Our profession still does not know exactly what a subluxation is, or how and why a spinal adjustment works. We do have almost a century of clinical observation that patients "get well" under chiropractic care, but that does not prove the original Palmer subluxation theory is correct. What we really have after a hundred years is a great number of very interesting theories that have yet to be validated.
But the concept of vertebral subluxation is alive and well in chiropractic, and is the major topic of discussion at conferences sponsored by many of the "mixer" and "straight" chiropractic colleges alike. LACC is presently promoting seminars in California titled, "The Subluxation Revisited"; Sherman College launched the first "National Subluxation Conference" last month; Life College West and the ICA are sponsoring a series of seminars which include four weekend courses on the vertebral subluxation complex. The ACA Council on Technic has initiated a program of inviting representatives from all chiropractic techniques to present their models of subluxation theory at open forum conferences.
It seems that Dr. Barge is missing the fact that a "new world order" is beginning to emerge in the chiropractic profession. At these conferences, chiropractors representing widely divergent theories of subluxation are sitting down together and for the first time actually listening to one another. As we begin to honor our fellow colleagues' opinions rather than attack them, we begin to recognize that there are some things upon which we all agree, and the vertebral subluxation is certainly at the top of the list.
Dr. Barge epitomizes the anti-science, anti-change attitude that permeates much of our profession. If some chiropractic theories are no longer accurate given our present state of knowledge, then we have two choices: change our theories to fit the facts, or change the facts to fit our theories. Dr. Barge seems to prefer the latter choice, which is the decision to use dogma, the practice of offering opinions as facts.
A science is a branch of study concerned with the observation and classification of acts. Chiropractic science must, therefore, modify its theories to fit the known facts, otherwise we revert to the practice of dogma. Philosophy is a body of principles underlying a branch of learning. Being scientific does not mean that we must abandon our chiropractic philosophy of innate healing, only that we abandon old disproven theories and dogma.
Michael Schneider, D.C.
Pittsburgh, Pennsylvania