Dynamic Chiropractic - July 17, 1995, Volume 13, Issue 15

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Book Reviews

Title: Toward a Philosophy of the Science of Chiropractic: a Primer for Clinicians Author: Joseph C. Keating Jr., PhD Publisher: Stockton Foundation for Chiropractic Research 2027 Grand Canal Blvd., Stockton, CA 95207 Price: $59.95

Dr. J. Keating, at the time of this publication, was a professor at Palmer College of Chiropractic/West Sunnyvale, California. He now has a position at Los Angeles College of Chiropractic, in Whittier, California.

After reading this book once I was not sure if I enjoyed it, was upset at Dr. Keating, or was just disgruntled with the profession on a whole. But six months or so later I read it again and found myself very much in agreement with a lot of the points that Dr. Keating brings forward.

Most of my life I have studied Japanese Haiku. I can't think of anything more appropriate to say about Dr. Keating's book than the words of the Japanese poet Bashu:

"Do not follow in the footsteps of the men of old. Seek what they sought."

This text is 451 pages of hard hitting facts, references, quotes, and inferences that will have you glued to the pages: sometimes happy, other times disgusted; sometimes in laughter, and sometimes in sorrow, but still you will want to read on. There will be some, I suspect, that will launch this book across the room only to pick it up a few days later; there will be some who will most definitely trash it, as the truth sometimes hurts. Let me give you but a few examples of what I mean. Consider this quote from page 35:

"It is the task of the intelligent chiropractor to examine his techniques and his clinical results in the light of established principles in the fields of body mechanics, neurophysiology, and pathology, and to formulate rational theory integrating his data with these principles" -- Weiant.

These are the crossroads of chiropractic today. "No problem," you say. "Big problem," Dr. Keating points out, because this quote was made by Weiant in 1944! We have still not achieved this level in 1995!

On page 44, Dr. Keating writes:

"The continued promotion of rigidly held clinical concepts is not likely to be tolerated for very long in a health system which is moving towards the rationing of care. 'Lesions without reasons' will not only not impress the economic gatekeepers, but will hasten their rejection of the potentially useful and testable consequences of subluxation-related health care. The more we insist that we 'already know' that subluxations are real despite strong evidence, the less credible we become."

With the rapidly advancing tidal wave of managed care facilities the more critical statements like this become. Dr. Keating points out many other interrelated topics and urges chiropractic and chiropractors not to throw the baby out with the bath water, a concept that we excel in.

The book is broken into four major divisions. Part I is the Orientation to the Philosophy of Science (five chapters); Part II is Education in the Methods of Clinical Research ( 10 chapters); Part III is Organizing the Profession for Clinical Science (three chapters). This part is exciting, as it shows chiropractic's failure with respect to literature, professional associations and the educational institutions that now exist. Part IV is References and Appendices. Even if you hate this book you will want this section because it contains all the material that you will use in medical legal matters and report writing.

With respect to our educational institutions Dr. Keating has this to say on page 345: "Perhaps most fundamentally, the chiropractic colleges and the profession itself must mature beyond the simple-minded spiritual and energy metaphors and the various flights of fantasy which still characterize much of the rhetoric among doctors (and, sadly, college trustees and administrators) today. Chiropractic doesn't need anymore founder/developer prophet/gurus who promise quick cures for everything and profits for the practitioner. The rhetoric of miracles and wealth-building need to give way to the sober attitudes of clinician-scholar-scientists." This is obviously aimed at a spot where the crude originates from and will cause some to vent their spleen, but isn't that exactly what Dr. Keating wants?

This text is a real sleeper, but one you need to read and read again. I loved it.

Innes Rating: 10 out of 10

Title: Beyond Results: Still More Observations of of a Chiropractic Advocate Author: William Esteb Publication: 229 pages, paperback Publisher: Orion Associates distributed by Back Talk Systems 2845 Ore Mill Dr., Ste. 4 Colorado Springs, CO 80904 (719) 633-1105 Category: Doctor/student self-improvement Price: $24.95

Mr. Esteb has done it again! Forty-one essay-like chapters brimming with his reflections on the unique advantages and positioning of chiropractic while also gently laying bare our soft underbellies and misconceptions. As John Whitney states in his foreward to this book: "Esteb has brought to chiropractic what Juran and Deming has brought to business management practice: a fresh point of view." Following on the heels of two other successful books, Esteb continues to help us view our world from new and different perspectives. This text focuses on issues such as honoring the patient (including expectations and learning styles), the most common excuses, fallacies and fears in modern practice and how to trim, tone and tailor your practice to succeed in today's tighter health care market.

Some chapter titles reflect Esteb's unfailing practicality: "The New, New Patient," "Converting the PI Practice," and "What Patients Expect." Others reflect his sense of humor and arouse the reader to solve the puzzle of the title: "Deep Ruts," "The Problems with Mall Shows," and "Are Cheeseburgers Hamburgers?" Most of us will see ourselves in the glass held up to our profession in more than one of these essays.

The book also establishes the foundation for growth in a modern practice such as family care, cash patients, referrals, and better communications.

The only detriments I found were moderate redundancy and the author's dogged insistence on the advisability of using pre- and post-treatment radiographs for patient edification. At best, this is a debateable point in chiropractic science based on patient risk.

Esteb's concepts, provocations and solutions are too endless to recount here. And I could not state it more eloquently than Mark Victor Hansen, author of the introduction of this book: "His thinking and writing will influence chiropractic into the 21st century."

Silvestrone Rating: 10 out of 10