The Chiropractic Philosophy and Practice10
Our chiropractic philosophy is based upon the fact that only the innate intelligence of the patient’s body knows what is normal and necessary for that individual, at any given moment. When we as chiropractors begin establishing what is normal for an individual we have stepped outside the realm of chiropractic by assuming we have, educatedly, the knowledge of the innate intelligence of the body. It does not matter whether we are establishing that need for an individual with symptoms (a disease) or an asymptomatic individual. Of course the question is always raised, are we not establishing a norm for the spine? “Aren’t we trying to get the spine to move into a position that we have established is normal and proper?” The answer is “yes,” sometimes we are, but that is not chiropractic either. That is the practice of orthopedics. Our analysis in chiropractic at best enables us to know only two things. First, where the bone does not belong (the ii of the body does not want it there) and second in what direction the innate intelligence of the body would like to move it. Making these two determinations is tremendously difficult and necessitates a sharp mind, training, practice and technical skills. Anyone who belittles the straight chiropractor as a mere technician undoubtedly has not worked to develop the skill or dexterity to completely analyze the human spine. It is like saying “Hey, how hard is it to hit a little white ball around a golf course?” It’s very easy. But doing it well, with a degree of skill, is not learned overnight (or in three trimesters). Analysis is such a difficult task that I cannot conceive how a chiropractor could or would want to take any time away from the task to try to master something else in the care of a patient.
So the chiropractor determines where the bone does not belong and in what direction it should move. Notice we do not say we know where it belongs, only that we know where it does not belong. Often we fall into the trap of assuming since we know where it does not belong, we also know where it does belong. Techniques that attempt to conform people to a standard or range can possibly and easily stray from the principle.
One of the major differences between straight chiropractic and other approaches is that we do not attempt to determine what is necessary and normal for an individual either in health and or disease, except to know that a vertebral subluxation is abnormal in any situation. Beyond that I would question whether anyone knows what is normal for an individual. However there is a profession that has as its objectives conforming people to its idea of normal. That profession is not chiropractic.
Chiropractic vs. Medical Standards
There are essentially two ways of practicing chiropractic. The one approach relates chiropractic to health. It maintains that the integrity of the nervous system is essential to health, and that health is the harmonious function of all the body’s parts and is dependant upon the nervous system for coordination. It recognizes the vertebral subluxation as a cause, perhaps the most important cause, for a loss of health. It does not relate chiropractic to disease but to DIS-EASE. The latter being an absence of EASE, a synonym for health. This type of practice only acknowledges disease in that it feels that persons with a disease, if they should coincidently also have DIS-EASE, should be under chiropractic care to have their EASE restored. Whether the restoration of EASE in any way is related to the existence of or the disappearance of the person’s disease is not the chiropractor’s concern. People need their EASE restored simply because DIS-EASE is detrimental to the well-being of all persons, diseased or not. This group, since it does not relate to disease, sees no need to diagnose it.
The second type of practice of chiropractic relates to disease. It says chiropractors should treat disease and/or its cause. Their treatment of disease may vary from simply adjusting a vertebral subluxation to any drugless procedure and now even certain types of pharmaceuticals. It is done to affect the disease. Those who are correcting vertebral subluxations are looking for the neuronal component in disease, addressing their attention to the reduction of that component, and monitoring the patient to determine whether the reduction has in fact made a noticeable and positive effect upon that disease. Within this segment of the profession there is also a subgroup which addresses its attention to removing a cause of disease or, depending upon whom you talk to, the cause of disease. This subgroup has as their main focus the subluxation which they feel is the primary cause of disease, although they appear at times to address nutrition as a cause. This entire group, both the disease treaters and cause of disease treaters, sees the need for chiropractors to diagnose. Those that treat disease must diagnose because it cannot be treated if it is unknown. The others say the disease must be identified in order to verify that the subluxation is its cause, and also in order to determine whether the disease can be expected to disappear once the cause has been corrected, or whether medical treatment is needed on a crisis basis.
The first type of practice is identified by the term “straight” and has a national association which represents its views. The second type of practice, relating to disease and/or its cause has its accrediting agency but also has two national organizations representing each subgroup. Its chiropractic colleges also align themselves with either the disease treaters or the cause of disease treaters.
With that rather lengthy explanation, let us look at a problem that confronts the chiropractic profession as a whole: whether it should be judged by chiropractic standards or medical standards. The first area relates to the efficacy of what we do. Chiropractic health practicitioners are free to establish the basis for what they do and the method for measuring success by any standard they choose. Why? Because they are delivering a unique service, a new and different service. No healing art has ever related to health as we define it. Medicine surely does not. They treat disease, cure disease, try to wipe out disease. If a patient went into an M.D.’s office with no disease and asked for “health,” he would be thought of as having a disease (mental!). Oh, the medics may give lip-service to “wellness” and “health care” but their emphasis is upon disease. Because we are uniquely relating to health we can establish the criteria for determining the validity of our approach. In straight chiropractic we have used deductive reasoning to do so. Logic based upon the a priori statement that “there is a universal intelligence in all matter which continually gives to it all its properties and actions thus maintaining it in existence” is our starting point.
If however we are going to relate to disease, any disease, either its treatment or removing the cause of it we must do so on the basis of accepted disease philosophy. That philosophy is medicine. Medicine uses empirical study for determining the validity of its procedures. We in chiropractic have not demonstrated that we have any claim to the treatment or cure of disease by empirical research. We do not deserve to exist within the framework of disease treatment unless we can prove the validity of chiropractic by their standards. Medical procedures and drugs to treat disease are not used on the public before they have been proven effective under strict, laboratory situations. If chiropractic is an alternative to medicine it must prove its effectiveness by the same criteria for each disease. Until it is proven by their methodology it should not be practiced. If we expect to be able to demonstrate the validity of chiropractic to the scientific (medical) community we are sadly mistaken. First, the scientific community will never accept chiropractic as a treatment for a microbe-caused disease. Nor will it be considered an effective treatment for hereditary or genetically caused problems, nor problems caused by diet, environment, etc. They have already accepted, proven (at least in their minds) treatments for those conditions. We will relegate chiropractic to low back pain as long as it does not involve a disc problem. You see, medicine has already determined by its sceintific methodology the etiology and the proper treatment for most every disease. Therefore, we cannot expect to prove chiropractic to the scientific community by their methods.
The scientific model is medical. It deals with diagnosis/treatment/outside-in cause philosophy. Chiropractic will never fit into the medical model. It is like comparing apples and oranges. We will always be a second class apple relegated to low back strains and sprains if we want to be judged by the medical model. If we say we are not apples but oranges then we can establish our own criteria for validity.
There is a second area where medical standards impact upon chiropractic. It relates to malpractice and chiropractic standards of practice. If we practice a health restoration type of chiropractic practice then we can establish our own standards and expect to be judged by those standards. However if we are to treat disease or treat the cause of disease then we must adhere to the accepted standards of disease care. Medicine has established them. As a profession we can expect more and more to have medical doctors on the witness stand as expert witnesses saying what the proper procedure should have been in a particular case. You can be sure that they are not going to be saying chiropractic was the appropriate care, especially if the patient has gotten worse and had to go to a medical doctor for treatment subsequent to the chiropractic care. He is going to say they should have gone there first! Here’s the point: it is not a matter of either/or. One procedure is best for the patient with a disease. Chiropractic’s “drugless treatment” may be better than medicine under most circumstances, but not all as far we are concerned! To the medical doctor, our drugless treatment is not better in any circumstance. If it were he/she would be using it. And that is exactly what the medical expert witness will be telling a disease-oriented jury in a malpractice case.
It seems clear to me that from the viewpoint of right to practice and safety standards of practice, the approach to the restoration of health which is the avenue taken by the modern day straight chiropractor is the only approach we can possibly take if our profession is to succeed and flourish.
We’re Doing Next to Nothing
I believe one of the reasons we as a profession in general and straight chiropractic in particular are having so little impact upon the public is that we have made chiropractic care inaccessable to much of society. Our fee systems, and more importantly our mindset concerning fees, are antithetical to our philosophy. Part of the problem is the insurance trough that we have been feeding at for the last fifteen years. In good capitalistic fashion we began charging what the traffic will bear, and the insurance industry will bear just about anything because they merely pass the costs on to the consumers. The consumer/patient doesn’t mind because he is only paying 10% of the cost of his care, through his premium. The other 90% is being picked up by the insured who are not patients in the form of their premium (this is based upon the accepted statistic that 90% of the public does not go to a chiropractor). Since the insurance company has only a medical model of health care they have no problem with chiropractors charging high fees.
There is nothing wrong with capitalism. I think it is the best economic system. But it is dependent upon two things. First there must be a free market. In chiropractic there is none. There is no one else capable of providing the service that we provide. The second and more important thing for capitalism to be successful depends upon the integrity of the provider. The capitalist must not try to gouge or take advantage of the consumer. Perhaps this lack of integrity is our greatest problem.
Part of the inaccessability of chiropractic due to fees is also the fault of the practice management people. They talk constantly about fair and equitable fee for services rendered yet I would venture to say, not one in ten of their parents could afford the fees they encourage their clients to charge. Their argument for high fees is that we are providing a great service to humanity, as important or more important a service then medicine. But that is an illogical argument. In one sense, the garbage collector provides a more valuable service than the M.D. Many people get along without physicians for years. But without the sanitation men, trash, garbage, rats, and disease would overwhelm us. Yet we do not consider that the garbage man’s wages should be higher than the M.D.’s. You cannot compare the two. Medicine and chiropractic are just as foregn to each other as are medicine and garbage collecting.
When it really comes down to it, the service we are performing as chiropractors is next to nothing. We do not heal people, the innate intelligence of the body does; we do not cure them, the wisdom of their bodies does. We do not take control of their health, they take charge of their own health. We do not even make the adjustment, the innate intelligence does it! We do next to nothing for a patient. I realize that it is a very great deal when compared to what every other health care practitioner is doing but we cannot compare chiropractic to anything else.
I’m sure this article will not sit well with a lot of chiropractors, but really, can we justify making well into six figure incomes for introducing a force to the spine three days a week, six hours a day. Most chiropractors who do learn to do it with any degree of proficiency learn on the very patients they are charging high fees. Granted we had to learn a lot of garbage along with learning chiropractic but should we penalize the public by making them pay for our profession’s stupidity? How much and how long should the patient pay because our education took a year or two longer and cost 30 or $40,000 more than it should? I’m not saying we should all take a vow of poverty or put a box on the wall. But if we are really serious about chiropractic for the world rather than just for the insured, then we better start putting our money where our mouth is.