When is the last time you found yourself trying to grasp the history of an era by looking at its relics and found yourself preoccupied (if not mesmerized) by their idiosyncracies rather than their intrinsic qualities? You became immersed in the crumbling ruins of columns, the sepia finishes of daguerreotypes or the scratches and pops of Edison wax discs on your way to uncovering the essence of the past. In fact, to give an example, you progressed to the point of not even being able to believe the authentic recordings of Al Jolson or Bessie Smith unless they were accompanied by the customary hisses and crackles representing the state-of-the-art of sound reproduction. As Marshall MacLuhan would have put it, the medium became the message and you lost sight of the actual voice qualities of these seminal artists.
This scenario in many ways is what has happened to chiropractic. In its 100-plus year history, we have closely identified the art and science of chiropractic with manipulation of the spine but have often lost sight of the concept of patient homeostasis, and the practitioner's own capacity to implement a wide assortment of noninvasive, drugless therapies to regions which often lie beyond the spine.
What the public has often lost sight of is that besides providing scores of manual, articular manipulative procedures, chiropractors have historically applied nonarticular manipulative therapies such as manual reflex and muscle relaxation techniques. In addition, they may employ such nonmanual procedures as exercise and rehabilitation; nutritional counseling; electrical and thermal modalities; bracing, casts and supports; traction; and even ultrasound. All these interventions have been documented with varying amounts of supporting evidence.1
The trouble arises when the concept of chiropractic becomes reduced to cracking the spine. This narrow perception is one-dimensional chiropractic at its worst. For starters, where does this leave the extremities? Such an approach disregards a large body of current research (much of which has been funded by FCER2) supporting the efficacy of chiropractic care in the management of cumulative trauma disorders in the extremities.2-4 There is yet additional research published which has reported the successful application of osteopathic or ultrasonic modalities in the management of carpal tunnel syndrome.5,6
One-dimensional chiropractic rears its ugly head in extremis when one considers the spate of papers which appeared in both the New England Journal of Medicine and the Journal of the American Medical Association.
Unfortunately, this carefully crafted interpretation of results was mutated by no less than the editor of JAMA. In an editorial in the November 11 issue which was intended to showcase (but not necessarily support) various types of "alternative" therapies, Fontanarosa and Lundberg gave only a hit-and-run reference to the Bove study, reporting that "Chiropractic spinal manipulation is not effective for episodic tension headache."11
It does not take more than a few sputtering brain cells to imagine how these three studies were interpreted by the lay press. Even though the Bove study was so much more carefully interpreted and presented fully within the context of previous research conducted by the authors, any information that could conceivably be considered to reflect positively upon chiropractic management was effectively censored. The message which inundated the public and which may unfortunately lap up to the transoms of prospective third-party payers from all these studies is simply that chiropractic is ineffective for all the conditions (low-back pain, asthma, and episodic tension-type headache) studied. As Damon Runyon might have put it, this type of distortion of scientific information is more than somewhat troubling.
The problem is basically one of communication. While the chiropractic profession talks about the importance of establishing a proper gatekeeper to health care, what we are really witnessing here is the lack of a proper gatekeeper to the media. As so eloquently concluded in a recent survey by Cheryl Hawk and her colleagues at Palmer University, "The disparity between the established view of chiropractic as synonymous with spinal manipulation and the profession's view of chiropractic as a complete system indicates a need for better interprofessional communication."12
At this writing, FCER and NCMIC are taking steps in an attempt to resolve this problem. A comprehensive monograph on the attributes and accomplishments of chiropractic by David Chapman-Smith is due within a few months. Additional personnel are being engaged by FCER and NCMIC to establish more systematic and periodic contacts with the major media so that the flagrant type of misinterpretations and design flaws discussed above will no longer become propagated as urban legends.
In so doing, I hope within the near future that we will no longer have to endure these hyperalgesic reactions to some of the distortions recently seen in both the medical journals and lay press. One-dimensional chiropractic, like the Edison wax disc, will then find a more appropriate resting place in an archive rather than the public forum.
References
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
