I have been reading the article, Chiropractic as Spine Care: a model for the profession, from the journal, Chiropractic and Osteopathy, these past few days and I thought I'd write a post on this subject.
In the article, the Palmer Postulates were discussed. Many people today still hold true to this hypothesis and refer to themselves as "philosophy chiropractors". I for one think they are loony and this article backs me up and adds depth to what I have written about over the past year now.
The Palmer Postulates are written as such:
1. There is a fundamental and important relationship (mediated through the nervous system) b/n the spine and health.
2. Mechanical and functional disorders of the spine (subluxation) can degrade health.
3. Correction of the spinal disorders (adjustments) may bring about a restoration of health.
In a nutshell, this hypothesis suggests health will be restored and maintained via a subluxation free spine. Some have referred to these folks as vitalists. To be clear, a vitalist is defined as, "the theory that the origin and phenomena of life are dependent on a force or principle distinct from purely chemical or physical forces." These belief systems are the reason people view chiropractic with skepticism. In the article, the author noted on the rejection of vitalism in the 18th century which lead to huge scientific discoveries and the beginning of the chemical and industrial revolutions. Modern medicine was founded in that era and continues to push forward with this unified foundation for health. Adhering to science creates trust in the public's eye. With that said, medicine lacks a lot of preventative approaches that are not vitalistic in nature but desperately needed. Meaning, fitness, nutrition and other proven methods of obtaining wellness are lacking or absent.
When studying these issues in my undergraduate program at Boise State, I learned early on the reason for this unfortunate lack of coverage for these "wellness" services is that it is hard to prove it works for the long run. If we invest into prevention, there is a chance the cost of it all wont pay us back in the future. We all know this is not true because fitness builds strength and longevity which overlaps into all areas of life such as work, sports and family life. The only negative consequence with fitness is overtraining or risk of injury. It comes down to deciding whether you want to risk getting heart disease, diabetes or any other chronic/preventable disease versus IT band syndrome or tendonitis. Seems pretty simple to me.
To loop back to the original discussion, even though these preventative services are lacking this doesn't mean we should revert to a vitalistic mentality. A quote from the article fits well here,
"an individual physician of any type may have religious convictions that inform their professional lives, and yet these convictions remain totally outside the domain of the profession's common identity. Similarly, an individual chiropractors belief (or non-belief) in vitalism can be considered to be entirely a personal matter so long as these beliefs do not distort the discharge of professional duties and obligations."
We can go to church and worship a God or whatever but we must operate with the understanding that believing something doesn't give us special powers unbeknown to science. Thinking back to when the chemical and industrial revolution began, these folks were brutal in their discoveries. Inoculating people with untested vaccines, for example, scared a lot of people. It went against the old ways and unfortunately killed a lot of people. Palmer was a guy that hated this concept. He formed an idea but never tested it like a scientist would if looking for the "answer". He sort of went with it and never looked back. This is unfortunate because so much time was lost and now research in the chiropractic world is in it's infancy. At this pace, the profession will move quite slow to make new discoveries. This is why I love the evidence-based practice movement in the profession. It stamps out vitalism with science!
The authors did their best to illuminate the fact that simply running with this hunch has gotten the profession nowhere. I might add that the surge in students wanting to be alternative care practitioners is due to big pharma pushing it's cure-all remedies to the public during the past 15-20 years. It isn't that chiropractic has made a new discovery, it is that people are tired of being drugged for everything. If we want to really piss the vitalists off we'd take a look at their reasoning for continued bodily function of major structural abnormality diseases. The authors wrote, "Why is it that a scoliotic, osteophytic, degenerated spine with asymmetrical facets and collapsed discs can so often result in no clinical problems?" "Or, conversely, why is it that someone with no identifiable anatomic spinal disorder can suffer from low-back disability."
It is kind of a conundrum, isn't it? Why are we going to chiropractic school if the original theory has been rejected? I can only answer for myself. My personal reasons are to learn more about the structure and function of the body in order to help my patients/clients at a higher level than what I was helping them at as a personal trainer. It doesn't matter if there are vitalistic people in my profession. In all honesty, we aren't a "profession" in the traditional sense. We are becoming one through research and unification but if vitalism isn't rejected completely we'll never be a profession. To add to this, I have written an excerpt from the paper below. It is quite lengthy but quite representative of the current state of affairs with our professions professional development.
"A profession is not defined by a set of ideas and values. Professions may have ideas and values, but these are not what distinguish or differentiate them as professions. Those organizations that are defined by ideas and values are entities like political parties, ideologies, religions, or organizations devoted to narrow issues like pro-life or pro-choice organizations. For those organizations, it is correct to state that the idea comes first, and everything else -- strategy, tactics, etc. - flow from the question: what will best promote our idea?"
"A profession is about a specific vocational role that the profession fills. A profession is defined by the work it does and teh role it fills, not by its ideas and values. The ideas and values of a profession must be secondary - they exist to answer the question: "How can we best discharge our designated role in society?" Professions do not or should not exit to be champions of ideas. This is most specifically true of the licensed professions. Society grants a license, a franchise, to a profession, not so that profession can champion its ideals, but because society wants some specific work done and it feels that granting a franchise is the best way to do it. This social contract is quite explicit. In most cases the vocational role of professions is quite obvious and can be stated in a few syllables:
Tooth and gum care.
Design and engineering of buildings.
Measurement of financial performance.
Legal services.
This simple and coherent vocational role is what the chiropractic profession seems to have so much difficulty in defining, and what the ACC paradigm fails to provide. Among the reasons for this failure is that chiropractic has always been confused about the concept of a profession and has tended to view itself a champion of ideas rather than as a provider of service. This confusion is perhaps understandable in an historical context. Chiropractic didn't begin as a profession; it began as an idea or set of ideas (vitalism, subluxation). Palmer and company were champions of these ideas, competing with charlatans and learned (not scientific) professional rivals for status. Over the decades, the institutions and each individual chiropractor saw themselves as a champion of the chiropractic idea.
But, at some point over the last 100 years, and unbeknownst to the individuals and institutions of chiropractic, it became a profession with a specific vocational role. As these thousands of chiropractors over the decades were advancing the ideals of the profession through manipulation of the spine, the public, which is largely disinterested in the ideas, decided that chiropractic had a professional role to fill. Thus, creating the profession as it exists today."
"A somewhat different state of affairs obtains for those health professionals whose clinical purpose is not defined by a patient population, buy by a specific technique or skill. To define the clinical purpose of chiropractic, it is necessary only to observe what chiropractors actually do and for what purposes patients seek care from doctor's of chiropractic: the provision of portal-of-entry care for the diagnosis and management of back pain, neck pain, and related disorders. In the shorthand that the public might use, chiropractors are back doctors."
Like it or not, we are back doctors. This is what the public expects and this is what we must use to build our businesses. In my mind, there has to be a way to connect the dots, so to speak, with fitness and nutrition. A model of wellness and performance versus pain relief. It can be done because everyone has the right to build a cash business incorporating really any ideology. If the ideology steps into the vitalist arena, I think that goes against scientific judgement. Lots of literature exists in exercise science and nutrition. Being that these principles haven't been adopted by many professions beyond personal training and coaches, we might want to do just that. At least we'd send a statement saying we are science based and ethical.
I need to study for our evidence-based practice exam, go figure.
All for now
