Philosophy and Science versus Dogmatism
in the Practice of ChiropracticThis section is compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org
FROM: J Chiropractic Humanities 1998; 8: 55–66
By: David Seaman, D.C.
This article is reprinted with the permission of National College of Chiropractic and JMPT. Our special thanks to the Editor, Dr. Dana Lawrence, D.C. for permission to reproduce this article exclusively at Chiro.Org!
Introduction
In the minds of many chiropractors, there is an ongoing battle in the chiropractic profession between two factions, one of which believes that the practice of chiropractic should be guided by philosophy and another which believes that science should guide the practice of chiropractic. It is my contention that a battle between philosophy and science does not and cannot exist within the chiropractic profession or any other discipline. I contend that the real battle is between the great majority of chiropractors who unknowingly allow dogmatism to guide the practice of chiropractic and the extremely rare variety of chiropractor who's practice of chiropractic is guided by philosophy and science.
In this paper, I will attempt to utilize the so-called "Socratic method" to guide the presentation of information. The "Socratic method" is characterized by a demand for accurate definitions, clear thinking, and exact analysis [1, p.8–9]. In Durant's commentary on Socrates, he states:
"Philosophy begins when one learns to doubt-particularly to doubt one's cherished beliefs, one's dogmas, and one's axioms. Who knows how these cherished beliefs became certainties with us, and whether some secret wish did not furtively beget them, clothing desire in the dress of thought? There is no real philosophy until the mind turns around and examines itself. Gnothi seauton, said Socrates: 'Know thyself' [1, p.8–9]
It is my perception that the chiropractic profession and the practice of chiropractic lacks a sound philosophical foundation, and that this exists in part because we do not appropriately and consistently examine our beliefs, dogmas, and supposed axioms. This will become evident in the remainder of this article which endeavors to define and describe key terms and concepts such as relativism, dogmatism, philosophy, and science.
Analysis of Definitions
Chiropractic Relativism
The word relativism is defined as "any theory holding that criteria of judgment are relative, varying with individuals and their environments" [2]. It is thought that this philosophy officially entered American dictionaries and/or texts around 1860-65.[2] Indeed, Noah Webster's first American Dictionary of the English language, published in 1828, provided a definition only for "relative" and did not contain a definition for relativity or relativism [3]. However, more recent versions of Webster's dictionary define both relative and relativity.
Interestingly enough, although the words "relative", "relativity" and "relativism" are nearly identical, they have entirely different meanings with no perceivable relationship to each other. "Relative" is defined as "related to, referring to, having connection with; relevant, pertinent," and "resulting from, dependent on, existing in relation to, connection with something else; proportionate, comparative; not absolute" [4]. It is intriguing to note that the definitions of relativity and relativism ignore the precise context of the definition of "relative" and focus only on the "not absolute" component of the definition. In philosophy, relativity is defined as "the doctrine that knowledge is not absolute or positive, but depends on the relations in which things stand to each other, that it can be concerned only with such relations, and is limited by the changing conditions in of our perceptual faculties" [4]. Relativism is defined as the "doctrine of those who maintain the relativity of knowledge" [4]. Clearly, the definitions for relativity and relativism suggest that there cannot be absolute truths; instead, truths and falsehoods are equivalent. In other words, the answer to the same question can be both true and false; depending on your point of view. The obvious inherent danger in the philosophy of relativism is that it permits us to glorify personal opinions and dogma as fact and truth.
Unfortunately, relativism plays a significant role in guiding chiropractic practice. Chiropractors commonly state that, "this is how I explain subluxation," and each goes on to promote his/her own unique opinion about the nature of subluxation. For nearly every chiropractor, there is a different description of subluxation and equally different methods of correction. Relativism in chiropractic, that is chiropractic relativism, also permits each chiropractor to define the nature of chiropractic in any way that he/she chooses. According to Bachop [5]:
"The incoming students graft their personal philosophies onto chiropractic teachings. The result is a hybrid each student calls "chiropractic philosophy." The diversity of personal philosophies results in a diversity of hybrids, that is, a diversity of chiropractic philosophies; and henceforth each graduate will think he knows what chiropractic philosophy is, or at least what it should be."
Bachop's comments were published in the first edition of this journal. Unfortunately, little has been done to correct the problem of chiropractic relativism. Instead, it is urged that we are tolerant of each other's dogmas no matter how absurd and inaccurate they may turn out to be when analyzed from a scientific/philosophic perspective.
Dogmatism
Dogmatism is defined as "unfounded positiveness in matters of opinion," and the "arrogant assertion of opinions as truths" [2]. A dogmatist is "a person who asserts his or her opinions in an arrogant manner" [2]. When cornered with unavoidable facts it is likely that a dogmatist would count on the philosophy of relativism to support his/her claims.
The information in this section will demonstrate that the problem of dogmatism in chiropractic spreads throughout most sectors of the profession, and that many chiropractic practices are guided by dogmatism instead of philosophy and science. As a profession, we should confess that if dogmatism is strong in our graduate's practices, it must be equally strong in our colleges. Despite this likely possibility, we would be hard-pressed to find a chiropractor or educator who would proudly state that "I am a dogmatist." Indeed, no one believes that he/she is a dogmatist, and no one wants to be thought of as a dogmatist, because the negative connotations are perceived to be quite significant. I will try to offer a different perspective on the nature of dogmatism, so we can more efficiently criticize our own dogmas.
Dogmatists are typically viewed as having unchangeable views; their minds are thought to be closed to different ideas and information. Clearly, this description characterizes most of us when we are confronted with information that is new to us. The natural human reaction is to resist new information, because it might require us to (a) alter the perceptions to which we are accustomed, and (b) accept the fact that we may be ignorant about issues we thought we understood. Based on this information it is reasonable to conclude that dogmatism should be the norm, rather than the exception. With this in mind, it should be obvious that we all need to routinely go through the pain associated with doubting our cherished beliefs and dogmas; it is the only healthy way to learn and grow.
In the following paragraphs, I present examples of obvious dogmatic writings in the chiropractic literature. Although I will focus on the comments of specific contemporary chiropractors, I believe that these comments represent the views of many chiropractors.
Consider the following title for a paper presented by Barge at the 1991 International Conference on Spinal Manipulation: Is there a true chiropractic philosophy? Yes, and there are no alternatives [6]. Despite the bold assertion found in the title, the abstract of this paper tells us only that there is a chiropractic philosophy, it is the philosophy put forth by the founders of chiropractic and that it is "irrefutable." However, Barge never discusses the nature of the philosophy and is apparently unaware of the fact that a philosophy, by definition, cannot be irrefutable. Comparatively speaking, papers presented by Winterstein [7], Gelardi [8], and Donahue [9] provide clear definitions and rational explanations which exemplify a philosophical thought process.
We are provided with more information regarding the one-and-only, irrefutable chiropractic philosophy in a text entitled One Cause, One Cure. In it, Barge states:"The art of adjustment evolved into the science of chiropractic, the explanation of nerve encroachment caused by vertebral subluxation and how it impaired health; and from this sprang forth the philosophy of chiropractic which explains the 'One Cause, One Cure' of disease." [10, p.2]
It should be understood that Barge's assertions are dogmatic. As an example, DD Palmer stated that there were three general causes of disease, including trauma, toxins, and autosuggestion [11, p.359]. Foreign to DD Palmer's writings is the "one cause, one cure" dogma, which constitutes a "spiritual disconnection theory" of chiropractic. This theory will be discussed more in the section devoted to philosophy.
In One Cause, One Cure, Barge also provides the following quote which further demonstrates a strong reliance on dogma:"I often say to chiropractor thick or thin, short or tall, exercise daily or not at all, eat at McDonalds or dine a the Ritz... it makes no difference, subluxation free you are healthy. Yes, if your body is functioning properly you can live out of a garbage can. Street people across the world prove this to be true. In all of the filth and germ ridden existence of their unsheltered world, these people survive. Certainly some do consume (sic) to their environment, but the fact that many survive is testimony to Innate adaptation. And this adaptation is adequate as long as the nervous system is unimpaired in its endeavors to provide Innate adaptation." [10, p.93]
Dr. Barge here again ignores the model of disease causation set forth by DD Palmer, and strongly asserts his opinions about chiropractic and health with unfounded positiveness.
In the President's Message column for the ICA Review [12], Barge opens by writing, "me thinks it is time to 'set something straight'." He continues:
"You see, education constipates the mind. We have sacred cows and beliefs that will not allow us to think clearly. BJ wanted all chiropractors to 'get the Big Idea'. The 'Above Down, Inside Out' philosophy of health and life ... He wanted chiropractors to be cognizant of the force of Life and its flow from Universal to Innate to Educated Intelligence; from God to man, so to speak."
Apparently, Barge believes that BJ Palmer is the one true forefather of chiropractic. He seems to suggest that BJ's ideas are preeminent and educational endeavors unrelated to BJ's ideas are detrimental because they create preconceived ideas that will hinder the mind from comprehending the ideas of BJ. In this regard, Barge states that, "this is why BJ Palmer always stated it was easier to train an uneducated person to become a chiropractor than an educated one" [12]. First, such dogmatic assertions run contrary to the nature of philosophy, as will be seen in the following section. Second, such a view of education is inconsistent with DD Palmer's, who believed that education was essential:
"There are two classes of Chiropractors, those who desire to know all they can of physiology, pathology, neurology and anatomy, and those who have an aversion for intelligence, do not want to take effect into consideration, depending only upon an examination of the spinous processes." [11, p.334–35]
It should be understood that dogmatism also exists within the community of chiropractors who claim to represent a scientific perspective; the problem is just not so overt. Consider the following opinion of one of the ACA's Board of Governors, printed in the Journal of the American Chiropractic Association:
"The spinal subluxation, though we have been correcting it with spinal adjustment for 100 years, is not fully understood. Scientific research presently is not sophisticated enough to determine the neurophysiological impact that spinal subluxation has on our patients" [13].
Specific questions should immediately come to mind after reading this quote. First, how can we be sure that we have been correcting anything for 100 years, if we do not fully understand what we are supposedly correcting? Obviously, we cannot be sure. We only know that we have been adjusting spines for 100 years and people seem to feel and heal better as a consequence of our intervention. Second, how is it possible for a private practitioner to be knowledge-able enough on the depth and breadth of scientific research to suggest that science is presently too unsophisticated to determine the neurophysiological impact of spinal subluxation? No rational scientist would make such a dogmatic statement. In fact, months before the above statement was made, scientists had proposed a reasonable neurophysiological mechanism by which somatic dysfunction/subluxation could promote symptoms of visceral disease [14]. Some of the most convincing neurophysiological evidence to support the contentions of these authors was published before 1955 [15].
In another issue of the Journal of the American Chiropractic Association, Harold Kieffer, an ACA Governor states:"And while chiropractic procedure is curative and/or beneficial for many types of health problems other than just ailments of the back and spine, the 'one cause, one cure' claim is unthinkable, unscientific, and unacceptable in today's enlightened society" [16].
This quote illustrates the common dogmatic double-talk of ACA members who, in one breath, castigate the so-called straight chiropractic philosophy which often implies that Innate Intelligence can heal anything and every-thing, and in the next breath, confidently imply that chiropractic care can cure or benefit numerous unmentioned or unstudied ailments.
Unfortunately, in recent years, a sophisticatedly insidious variety of ACA styled dogmatism has emerged in the name of science, which interestingly enough, bears a striking similarity to the style of BJ Palmer. Recall that in the famous Green Book collection, BJ Palmer predominantly transcribed his thoughts onto tablet. Rarely, if ever, did BJ cite references to support his claims. Apparently, his teaching style was no different. Over time, impressionable students would come to accept BJ's spoken or written opinions as fact, citing his opinions as credible references. Even today, some students and doctors continue to cite the opinions in the Green Books as well-documented facts that should not be questioned, while simultaneously pro-claiming that modern scientific texts are deficient or outdated; a glaring example of dogmatism.
In the recent years, the work of Dr. Frederick Carrick, president of the ACA Council on Neurology, has resulted in a style of dogmatism that echoes that of BJ Palmer. In the case of Carrick, students believe that his words represent state-of-the-art, referenced material. Comments and conclusions made on the web site of Dr. Mark Burdorf help to illustrate this point [17]."Dr. Fred Carrick, who is my neurology professor, recently published his dissertation, Neurophysiological Implications in Learning, in order to fulfill his requirements for the degree of Doctor of Philosophy in Education. He did a study on five hundred participants where blind spot mappings were produced with change noted before and after chiropractic adjustments. The results of blind spot mappings should be equal. Changes in function from right to left lead to dysfunction which can lead to a variety of disease conditions. The importance of this simple diagnostic tool has great neurologic significance in determining how chiropractic care should be directed in order to maximize your human potential.
Patients that have unequal blind spots can present with a variety of symptoms. Realize that if you have a large blind spot in your left eye compared to your right eye you cannot perceive vision as well from that left eye and you will have to tilt your head to compensate for this. The changes in head position have major effects on body mechanics. Patients that have a large blind spot often remark that they have a tendency to walk into walls or worse, end up in your office because they were involved in an auto accident because they didn't see the other car coming.
To make matters worse, people that are in an accident and do not receive proper care for their injuries often find that they keep getting into more accidents because their blind spots continue to worsen and they suffer an increasingly poor state of central integration."Most of the above statements and conclusions about blind spots are not supported by the literature devoted to chiropractic care and vision [18–27]. Even Carrick's recently published paper on blind spots [27] does not provide any evidence to support the definitive conclusions made by Burdorf.
In an article published in the ACA's Journal of Chiropractic, entitled "The New Vertebral Subluxation," the author supports most of his claims by referencing Carrick's lecture series, course notes (referred to as a Textbook of Neurology) and videos, none of which offer supportive citations. This Textbook of Neurology was made available to students during the mid- 1980's through the early 1990's [28]. Unfortunately, some errors are present in the section devoted to the cerebellar afferent and efferent pathways, such that Carrick promotes the existence of pathways that do not actually exist in humans and other mammals. For example:"The information from the lower part of the body will enter the dorsal horn where there is a synapse with secondary neurons which rise rostrally in the ventral spinal cerebellar tract of the lateral columns... The information from the proprioceptors coming from the upper part of the body is through a different pathway. These fibers travel along the dorsal spinocerebellar tract where they synapse with secondary neurons in Clarke's column" [29].
Long before Carrick ever began teaching diplomate courses in neurology, it was a well-known fact that both the dorsal and ventral spinocerebellar tracts are concerned with transmission of impulses from the lower extremity, while the rostral spinocerebellar and cuneocerebellar tracts are concerned with the upper extremities [30]. Simply stated, when an instructor implies that he is correct and accepted scientific texts are wrong, he fosters an instructor/student relationship that leads to unbridled dogmatism.
In addition, the manner in which instructors respond to questions can also lead to dogmatism. As an example, an instructor can create an atmosphere of intimidation which causes students to be afraid to ask questions for fear of being embarrassed in front of their peers. This situation promotes a classroom environment of passivity and receptivity on the part of students, which naturally fosters a compliance to, and a reliance on, the dictates and dogmas of an instructor. Carrick demonstrates this tendency in recent letters to the editor. When asked to explain or clarify certain concepts and issues [31,32], Carrick responds by discussing the theoretical shortcomings and ineptitude of the questioner [33]' or simply avoids answering certain questions and instead reasserts the veracity of his original points [34]. On the other hand, when Carrick is complimented by students who do not question the veracity of his contentions [35, 36], he praises them for their inspiring vision and foresight [37, 38]. Such methods of negative and positive reinforcement can engrain dogmatic beliefs in those who are susceptible.
In summary, it is clear that dogmatism plagues the chiropractic profession at large. Neither the so-called straights nor mixers, as groups, have been spared from this plague. Unfortunately, the leadership for each faction of the profession refuses to initiate a thorough examination of their respective dogmas; instead, each side focuses on the inadequacies of the other's dogma. Gelardi stated the problem clearly [39]:"Both sides use their counterparts as convenient whipping boys for their own shortcomings in leadership. The leadership on both sides, in their efforts to build a following and call it to action, often rely on instilling fear of the other side to get the job done. Each side blames the other for the division and for lack of any substantial professional progress."
It is painfully clear that our profession, at large, needs to undergo a process of self-examination and re-education. It appears appropriate that we should begin this process by developing a better understanding for the meaning of philosophy and science.
Philosophy
As with many words, philosophy has several definitions, all of which clearly demonstrate the need for philosophy in both our professional and personal lives. It is unfortunate that many in chiropractic confuse dogmatism with philosophy, and subsequently suggest that philosophy has no utility in the practice of chiropractic. Naturally, and rightly so, such assertions outrage the proponents of philosophy, even though the majority of these so-called "proponents of philosophy" are really supporters of dogmatism. The end result is an ill-founded, profession-wide dispute over the topic of philosophy. In reality, this dispute has little to do with philosophy and centers mostly around the posturing associated with defending strong personal attachments to respective dogmas. It is my hope that the following commentary on philosophy will help to add clarity to an issue that should never have been muddled in the first place.
Philosophy has been defined in the following ways:
Literally, the love of wisdom [3].
The rational investigation of the truths and principles of being, knowledge or conduct
The critical study of the basic principles of and concepts of a particular branch of knowledge, especially with a view to improving or reconstituting them [2].
A system of principles for guidance in practical affairs [2].
A discipline comprising logic, aesthetics, ethics, metaphysics, and epistemology [40, 41].
As indicated by these definitions, philosophy connotes a clarity of thinking and the willingness and commitment to conduct a critical inquiry and examination of one's beliefs for the purpose of abandoning incorrect notions. When applied to chiropractic, philosophy demands that we examine our concepts about subluxation/joint complex dysfunction and methods of chiropractic care for the purpose of disposing in-correct concepts and methods. Unfortunately, this activity has not been effectively pursued by our colleges and research organizations. We talk and write about philosophy, yet many of our actions and words, outside of such conversations, are guided by dogma, as illustrated in the previous section.
Many in chiropractic have demonstrated that they have an understanding of the true nature of philosophy [8, 41–45]. In fact, Gelardi provided a particularly elegant and succinct description of philosophy for the profession to consider [8]. Despite the availability of such information, philosophy in chiropractic typically echoes that of mysticism, rather than critical thinking. This is perhaps because chiropractors overemphasize and misinterpret the nature of metaphysics as it relates to chiropractic practice.
Translated from Greek, metaphysics literally means after physics. "It is said that this name was given to the science by Aristotle or his followers, who considered the science of natural bodies, physics, as the first in the order of studies, and the science of mind or intelligence to be the second' [3]. Is it possible that this description is telling us to first study, understand, and master human biology before leaping into metaphysics? In my opinion, the answer is an obvious yes. We should first study and understand that which exists, and second study that which underpins or lies beyond that which exists.
Durant states that Aristotle's metaphysics grew out of his biology (1, p.56). Regarding Aristotle's biology, Durant maintains that "they form the greatest monument ever raised to the science by any one man" [1, p.55]. Indeed, "before Aristotle, science was an embryo; with him it was born" [1, p.51]. Whether one chooses to accept the above implications regarding the study of science and metaphysics is his/her own decision; however, one thing is certain, Aristotle himself did not place metaphysics above science or any of the other areas he studied, including political science, logic, psychology, ethics, or aesthetics. Why, then would chiropractors want to put all of their eggs into a metaphysical basket when attempting to describe and develop a philosophy of chiropractic (i.e., done by hand on a physical body)?
It must be remembered that metaphysics, while consisting of many divisions, still constitutes only one component of the discipline of philosophy [see definition #5 above]. The ancient schools taught that the science of metaphysics had numerous divisions including ontology, cosmology, anthroposophy, psychology, pneumatology, and metaphysical theology [3]. Pneumatology is the study of spirits and angels, while metaphysical theology, called theodicy by Leibnitz and others, deals with the existence, essence and attributes of God [3].
As it relates to the philosophy of chiropractic, Gelardi [8] and Koch [46] correctly maintain that metaphysics should not involve the supernatural; rather, "metaphysics is the study that pertains to reality, to the nature of things, to existence" [8]. Unfortunately, Gelardi and Koch are greatly outnumbered by those who see no difference among philosophy, metaphysics and metaphysical theology. In other words, according to most chiropractors, so-called chiropractic philosophy constitutes a type of religion or metaphysical theology.
For example, consider the following quote from "an open letter to the profession," published in Parker's Share magazine. Burnier states [47]:
"Chiropractic philosophy was ahead of its time but it is now at the very crest of the contemporary wave of consciousness They [the public] need Teachers and Mentors and Friends, who set examples of how to live from above down inside out. People are yearning for a return to spirituality and this begins with an immutable trust in Universal Intelligence without and Innate Intelligence within" (my emphasis).
It should be mentioned that Burnier was the winning author of Share's Article of the Month. Nearly every member of the chiropractic profession receives this publication, which equates philosophy with religion. In another magazine that is distributed to significant sectors of the chiropractic profession, Barge discusses the above down, inside out philosophy of health and life [12]. He emphasizes that BJ Palmer "wanted chiropractors to be cognizant of the force of Life and its flow from Universal to Innate to Educated Intelligence ... from God to man, so to speak." Indeed, the writings of BJ Palmer make very clear that he often focussed on religion instead of philosophy. Consider the following comments by BJ Palmer:
"Innate is God in human beings; is good in human beings, is life in human beings, is health in human beings, is sane in human beings. Let Innate flow in and through us and we can accomplish the great wonders." [48, p.56]
"In studying Innate, we have accomplished what all religions have always wanted to do, viz., make 'The Kingdom of God Is Within You' a tangible working integral part of living man. We have accomplished what medical therapies have always tailed to do but wanted to do, viz., found a specific cause for all disease (as there is but one) and a specific for the correction of that cause, thus making a living healthy sane God live healthily and sanely in man." [48, p.119]
Verily, I say unto you, all power cometh from within,' is no longer a mysticism of the East, but a practical, working, human principal of the West. Chiropractors who apply the science are proving the wisdom of Him who said, 'there is nothing from with-out a man that entering into him can defile him, germ theorists and dietitians, notwithstanding." [48, p.27]
"Within us, it is said "The Kingdom of God is within you." It is! Innate Intelligence is the Great I am that I am. Innate Intelligence is the internal source of all and everything." [48, p.48] "Within all natural animals, including man and woman, courses in active flow the wisdom of all time, the sage of the ages call it what you may-Universal Intelligence, God, Jehovah, etc" [48, p.23].
"May God flow from above-down its bounteous strengths, courages, and understandings to carry on; and may your Innate receive and act on that free flow of wisdom from above-down-inside-out; for you have in your possession a sacred trust. Guard it well" [10, p.148].In summary, BJ states that Innate Intelligence (or God) transmits information from the Innate Brain above, down to the body via mental impulses. According to BJ, mental impulses are very different than nerve impulses. BJ proposes that mental impulses are Godly or spiritual impulses, and that subluxations can interfere with, or block, the transmission of these spiritual impulses. In essence, as mentioned in the dogmatism section, this explanation offers a "spiritual disconnection theory" of subluxation, such that subluxations disconnect one from the consciousness of God and His healing forces. Within this belief system it is held that the chiropractor, through spinal adjustments, is directly responsible for releasing God's healing forces that were previously blocked by subluxations. With good reason, this explanation is unacceptable to many chiropractors.
I should make it clear that I do not dispute the potential of God's healing power; however, I do dispute the visionary presumption that God's influence on human beings can be encumbered by subtle spinal misalignments or even overt neurocompressive lesions. Such claims defy reason and the basic tenets of philosophy, and moreover, these claims cannot be supported by a spectrum of religious texts including the Bible, Tanakh, Quran, and Upanishads. Nonetheless, when a chiropractor questions the unsupported "spiritual disconnection theory" of chiropractic, he or she is typically characterized as a cold, heartless, God-less mechanist who worships the false god of science.
I should emphasize that my opposition to the "spiritual disconnection theory" should not be confused with an opposition to the concept of "nerve interference." In fact, it is clear that at least two situations can interfere with neural conduction, one being neurocompression and the other being reduced mechanoreceptor afferentation as a consequence of reduced joint mobility. A great deal more could be said about these topics; however, the focus of this section is philosophy and not neuroscience. Numerous papers discuss neurocompression, and a recent paper discussed reduced mechanoreception in some detail [49].
Unfortunately, our profession's problem with philosophy does not end with the misconstruing of religion for philosophy. A great misconception that pervades significant sectors of the chiropractic profession is the notion that "philosophy" is motivational and should make people feel good about themselves and what they do. For example, after attending a chiropractic motivational seminar, a chiropractic assistant stated that, "the chiropractic philosophy of love and togetherness is what healing is all about" [50]. Quite to the contrary, by demanding that we honestly and critically examine our profession's basic principles and concepts, philosophy can and should evoke some degree of doubt and discomfort, which would then motivate us to ask questions about chiropractic, which would in turn drive us to learn more about the nature of chiropractic care and the spinal phenomenon we claim to effect.
The extent to which chiropractors embrace dogmatism, mysticism, religion, and psychological motivation instead of philosophy is staggering. Rather than conduct an on-going philosophical investigation of chiropractic-related topics, the great majority of our profession espouses one side or the other of a false argument which pits science against philosophy.
Science
Noah Webster provided several definitions for science. One suggests that science is, "in a general sense, knowledge, or certain knowledge; the comprehension of understanding of truth or facts by the mind; in philosophy, a collection of the general principles or leading truths relating to any subject; any art or species of knowledge" [3] Similar definitions are provided by contemporary dictionaries [2, 4]. For example, science is defined as "systemized, coordinated knowledge based upon the accurate observation of facts, and the relation of these to general principles or laws; an inquiry into the causes and conditions which determine the character of the phenomena observed" [4]. By comparing the definitions of philosophy and science it becomes obvious that they can never he at odds with one another. Indeed, Geraldi states that, "I see philosophy and science as being symbiotic, the right and left hand attempting to applaud reality" [8]. It can also be said that the scientific method of investigation should be viewed as a practical application of philosophy.
Unfortunately, the topic of science, like philosophy, has historically been a source of arguments within the chiropractic profession. For example, it is argued that so-called scientific chiropractors are mechanists who refuse to consider the existence of vital functions in the body and, in so doing, abandon a major tenet of chiropractic. It is also argued that science is extremely limiting because it can only "take us so far." I believe that science-related arguments arise because chiropractors are notorious for confusing the "scientific method" with "science".
The scientific method of investigation is applicable in the case of either clinical or basic science research. However, the scientific method is rarely used in the standard clinical practice because it is the rare medical or chiropractic doctor who conducts research in his/her office. It can also be said that the "scientific method" does not apply in clinical chiropractic or medical practice, because caring for patients does not typically involve research. However we cannot say that science does not apply in clinical practice, simply because every day practitioners interact with the physiology and physiopathology of their patients.
Physiology is defined as "the branch of science dealing with the functions and activities of living organisms and their parts, including all physical and chemical processes" [2]. Physiopathology is defined as "the science dealing with the disturbances of bodily function resulting from disease" [2]. Thus, a scientific or science-oriented practitioner is one whose approach to patient care is by guided clinical research and by the dictates of science, i.e., physiology, physiopathology, biochemistry, neurology, anatomy, etc.
Within the chiropractic profession there is also a serious misconception regarding the nature of a "scientific, evidence-based" practitioner. For example, it is incorrectly assumed that such a chiropractor believes that adjustments are only useful for patients with certain forms of acute low back pain, because that is what was determined by a specific controlled clinical trial or an analysis of relevant controlled clinical trials. It must be understood that it is the extremely rare "scientific, evidence-based chiropractor" who determines his/her patient population based solely on such studies. In fact, I know of no chiropractor who practices in this fashion. Moreover, if all chiropractic and medical doctors were required to treat patients based solely on the outcome of controlled clinical trials, very few patients with any condition would ever be treated by any doctor.
It should be understood that all health care practitioners use untested methods, and all training institutions in the health care arts currently teach unproven methods [51]; and believe it or not, none of this is typically characterized as unscientific behavior. In principle, this means that chiropractic care is probably no more or less scientific than any other health care art.
Why, then, are chiropractors chastised as being "unscientific quacks," while medical doctors and other practitioners have managed to avoid that stigma? Mostly, it has to do with the claims that chiropractors make in marketing their services. Chiropractors are notorious for making treatment claims about chiropractic care that go well beyond the limits of our supportive data [51], whereas other professionals do not. Consequently, it is the chiropractor who looks like, and subsequently deserves to be called, an amateurish, unscientific huckster.
Unfortunately, chiropractors typically respond to this problem by claiming that there is not enough scientific research to support chiropractic care or, as mentioned above, by claiming that science is not yet sophisticated enough to determine the impact of subluxation [13]. In actual fact, science has provided a great deal of valuable information relevant to chiropractic. The problem is that the chiropractic profession at large is either unaware of this material or does not understand how to apply it to chiropractic care. Indeed, Nelson, commenting on a recent text devoted to subluxation, stated that "there is no nexus between basic science and subluxations except that both concern the spine" [52].
Clearly, the chiropractic profession has the same problem with science as it has with philosophy. We like to talk and write about the need to talk, write and focus on the nexus between science and subluxation; however, this activity does not extend beyond the idea that we need to do something at some time in the future. As a consequence, our descriptions of subluxation have not evolved to any notable degree in over 100 years. Consider the following attempts to describe subluxation:
1828: An incomplete dislocation [3].
1910: A subluxated vertebra is one that is displaced from its normal position by traumatism or poison. Chiropractic displacements are fixed, exaggerated lateral movements. Subluxations impinge upon nerves [11, p.69].
1927: A subluxation is the condition of a vertebra that has lost its proper juxtaposition with the one above or the one below, or both, to an extent less than a luxation, which impinges nerves and interferes with the transmission of mental impulses [53].
1992: A misalignment of one or more articulations of the spinal column or its immediate weightbearing articulations, to a degree less than luxation, which by inference causes alteration of nerve function and interference to the transmission of mental impulses, resulting a lessening of the body's innate ability to express its maximum health potential [54, p.29].
1992: An aberration of normal spinal biomechanics, usually involving a restriction or loss of normal movement of a motion segment, and associated with aberrations in the tissues which support articular motion (e.g., nerve, muscle, connective and vascular). [55]
1996: A complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health [56].
Clearly, these are incomplete descriptions as they provide minimal information about subluxation and body physiology; in short, there is simply no nexus between science and subluxation. These descriptions demonstrate that a basic science aptitude problem exists within the ranks of the chiropractic profession. This becomes particularly obvious when we realize that no additional information or research is presented to support the many descriptions listed above. Unfortunately, this problem is not acknowledged by most of today's chiropractors.
Our obvious lack of an integrated, foundational and scientific description upon which to build our profession should cause us to be concerned about our future role in the care of patients, but it does not. This anti-philosophical sentiment was clearly expressed in a special issue of Chiropractic Products magazine, which celebrated the Chiropractic Centennial by inviting authors to provide their vision of the chiropractic profession during the next 100 years. The great majority of contributors neglected to discuss any real problems that may retard professional growth and, instead, focused on how chiropractors will finally be vindicated and then properly viewed as physician-saviors. Consider the following examples:"The ICA (Interplanetary Chiropractic Association) announced that applications will be taken to allow the few remaining medical doctors still in active practice to have hospital privileges on a very limited basis" [57].
In the next hundred years, we won't be talking in terms of global chiropractic, but in terms of galactic chiropractic ... What a profound blessing it is to be able to work with the human nervous system and its vitalistic mental impulse. Wow! What an inspiration to become a master of masters, a doctor of chiropractic" [58].
It is likely that such visionary, cavalier, and capricious views about chiropractic begin for many in their first year of chiropractic college when they are told, by "experienced" third and forth year students, that the basic sciences are only necessary to pass board exams, after which one can go out and dispense the gift of making sick people well.
Regretfully, a poor science aptitude can be readily seen in our college students and in field practitioners. I was recently told by a reputable college instructor that most students entering neurological diagnosis classes are unable to adequately draw a cross-section of the spinal cord; a problem which is then taken into the field. At a recent state chiropractic association convention, I asked an audience of over 100 chiropractors to list the different nerve fiber types which make up a peripheral nerve. Not one chiropractor in this group could list a single specific afferent or efferent nerve fiber or its related functions.
In light of these types of problems, it should not be surprising that little progress has been made to create a nexus between science (particularly neuroscience) and subluxation. Indeed, how can a profession put forth appropriate theories or reject inappropriate theories if an adequate knowledge base regarding body function, particularly neuroscience, is sore lacking? In such an anti-intellectual and dogmatic environment, it is likely that research efforts [14, 49, 59–63] which could ultimately help to bridge the gap between science and subluxation will either go unnoticed by many due to a poor readership within the chiropractic profession, be misinterpreted and used to support inconsistent views, and/or be viewed as threatening and anti-chiropractic in nature.
Conclusion
Although the chiropractic profession has existed for over one hundred years, we have yet to adequately engage in a critical examination our cherished beliefs and dogmas. Consequently, personal opinions about subluxation, philosophy, science, and the nature of chiropractic will continue to dominate the chiropractic profession. We should all oppose this trend of chiropractic relativism and endeavor to build a chiropractic profession that is guided by real philosophy and real science instead of dogmatism.
Acknowledgments
Although the views presented in this paper are my own, I want to express a special thanks to Dr. David Koch, President of Sherman College of Straight Chiropractic, for his helpful comments during the development and preparation of this paper.
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