CAN SCIENTIFIC RESEARCH AND PHILOSOPHICAL CHIROPRACTIC CO-EXIST?

This was my presentation at IRAPS OCTOBER 2014. It caused quite a bit of discussion, less so as part of a talk at the Garden State Chiropractic Society Convention this past Saturday. I would like to get the comments of readers of this blog. I realize it is longer than the usual post but I think that was necessary in presenting sufficient information to engender adequate discussion.

ABSTRACT

Do we in the chiropractic profession believe that chiropractic is able to stand alone as a deductive science – apart from scientific research? Do we in the chiropractic profession desire that chiropractic stand alone as a deductive science – apart from research? Do we believe that we are not accepted by science, the health field, the public and even some colleagues within the profession because we do not prove the merits of our profession with scientific research? Most chiropractic research appears to foster the empirical, outside-in, experience-oriented approach to understanding and validating chiropractic as an effective alternative to addressing medical conditions and in doing so negates, subverts, or at least belittles the rational, deductive and philosophical approach, unwittingly purporting to make it unnecessary. Can research and philosophical chiropractic co-exist or does the very nature of chiropractic philosophy preclude it from the usual empirical, inductive, experiential methods ordinarily associated with medical practice? If our philosophy deduces that our objective is to locate, analyze and correct vertebral subluxations to enable the innate intelligence of the body and its forces to be more fully expressed, how does our research demonstrate empirical evidence of that deduction? Is it because sick people get well? The medical profession gets sick people well (in theirs and the public’s opinion) and has been doing so for thousands of years, not just since 1895. Is our research, in principle, agreeing with the medical profession that being sick is the same as having a medical condition or symptom and getting well is the same as alleviating that condition or symptom or its cause? Can chiropractic as a biological science adopt the research methods and systems associated with the natural sciences of empiricism? Can chiropractic philosophy and outside-in empirical research, especially that of addressing the value of chiropractic in the alleviation of medical conditions co-exist? If so, will this increase or decrease the value of chiropractic care, ignoring the benefit to millions of people not (or not yet) manifesting the signs or symptoms of medical conditions and in so doing have the opposite effect that it is intended to have? Chiropractic research is intended to answer many questions about chiropractic. Will it? Lastly, is there a place for research in chiropractic, consistent with its a priori, deductive philosophy, which will improve the public’s understanding and acceptance of our profession?

Presentation
Hans-Herman Hoppe of the Ludwig Von Mises Institute, in his book Economic Science and the Austrian Method, a series of essays and lectures, expands upon the argument presented by the great Austrian economist for whom the Institute is named, that “methods associated with natural sciences cannot be successfully appropriated for economic theory.” (1) He posits that economics belongs not in the natural sciences but in praxeology “the study of human action and conduct, relating to praxis, relating to an art, science, or skill.” (2) Hoppe’s mentor, Von Mises, did not see his ideas of Austrian onomics as something new. It was actually the common system historically, from the time that coinage was invented as a simplified means of barter. Even in this country when using coins, not coins made of wood
(hence the phrase “not worth a wooden nickel”), but coins that had intrinsic value (gold or silver) or paper that represented actual physical gold (stored at Fort Knox, Kentucky). The term “fiat” means simply “decreed” and “fiat money” means money that someone had established (decreed) to be of a certain value. There must be a standard. The standard was gold (except for periods of war in which fiat money was a promissory note, a ”greenback,” with a future promise to pay back in gold). During Franklin Delano Roosevelt’s administration gold was decreed to be worth $34.00 an ounce. The American dollar (backed by gold) and the British pound (backed by sterling silver) eventually became the universal currencies until Great Britain no longer had sufficient silver to back up the pound and then the universal currency became solely the dollar. That standard was abandoned in the mid-1970’s and the government embraced the idea of fiat money no longer backed up by gold in Ft. Knox but with paper dollars backed up by paper dollars with no promise to repay in anything of intrinsic value. That caused inflation which drove up the value of gold (to nearly $2000 an ounce) as well as other commodities and as a result, How does this relate to our chiropractic philosophy and research? Can we decree anything in chiropractic? If not, we have no principles. Studying, learning and applying the Thirty-three Principles then would be a waste of time and mental energy, Gold has intrinsic value. If gold is $2000/ounce, it does not matter whether that ounce is in a coin, a gold bar, a piece of jewelry or the filling in a tooth. Chiropractic also has intrinsic value. As an absolute,
our analogy breaks down because gold, like any commodity, changes with the amount produced or available and the value placed on the item. (A rare coin, a piece of jewelry, or a dental filling may all have the same amount of gold but be priced differently.) However, for our discussion purposes the analogy will suffice because the result of an adjustment is always the same. An adjustment is always 100%. The adjustment always perfectly and completely allows the innate forces of the body to be more fully expressed, regardless of the absence or presence of a medical condition in the recipient. The intrinsic value of an adjustment is not related to the fee set by the chiropractor. Its intrinsic value is in the chiropractic objective. The philosophy of chiropractic is based upon a priori knowledge in the form of a Major Premise, the first of the Thirty-three Principles, and the deductive logic of the remainder of the principles. It cannot exist within the philosophical framework of the medical model which depends upon relativism. This paper will be confined to arguments concerning research and the natural science methodology which assumes, within reasonable standards, that it can effectively predict the outcome (and value) of an action within the human body despite its countless variables and unique expressions of innate intelligence. I hope that other chiropractic philosophers will undertake the task of contrasting the specific chiropractic/ADIO approach and
the therapeutic/OIBU approaches to research. Objective Straight Chiropractors disagree with the philosophy of allopathy, osteopathy and much of New Age and complementary and alternative medicine (CAM) philosophy. It is not so much that we have gone off in a different direction, but that the healing arts have abandoned their traditional embrace of what we might call the ADIO model of life and health based upon, most importantly, our fixed Major Premise from which are derived minor, but just as valid, premises which have been codified or arranged systematically and explained by Palmer, Stephenson and others in what we commonly refer to as the Thirty-three principles.
Most all current practices that involve the human body are based upon empiricism, experience and induction. Prior to the Enlightenment, healing arts practices were based upon metaphysical, mystical and/or supernatural causes; from miasmas (noxious vapors), the night air, bad blood, divine discipline, displeasure or judgment by the gods. The cure, however, usually involved some physical action such as bleeding, closing a window to keep out the “evil” night air or sacrificing an animal or person to placate or satisfy a deity. Failure was attributed to “God’s will” or the will of evil forces (your enemy’s gods) overcoming the will of good forces (your gods). The caduceus of medicine is a remnant of one of those procedures. The Israelites who were bitten by venomous snakes in the desert had to look upon a brass serpent on a pole to be healed. This was a demonstration of their faith. After the Enlightenment and by the time chiropractic was discovered and developed, procedures involving experience and induction had become the “physical” action of choice (although the serpent on a pole remained!). Most healing arts that were still based solely upon the metaphysical and/or supernatural either passed from the scene (magnetic healing), adopted strictly physical approaches, ignoring their former metaphysical components (osteopathy and homeopathy), or relegated their practices strictly to religion (faith healing and Christian Science). Chiropractic seems to be the only “healing art” that has successfully made the transition. Whether that is because the others were based upon false premises, since we are now in a post-enlightenment period in which the metaphysical is once again considered valid, or because chiropractic is a system that is founded upon identifiable truths is a subject that needs to be explored further. That subject is not relevant to this paper, unless those identifiable truths can be brought to light by research. I realize that I write/speak from a personal and admittedly biased non-therapeutic viewpoint and I do not represent any particular group or organization. That gives me a freedom that some present today do not have. I would welcome professional discussion with my presentation. IRAPS is the appropriate venue to have that discussion. While some would like to see and to establish IRAPS as a vehicle for establishing and demonstrating two sides of the same coin, working together to strengthen the chiropractic profession, I must question whether it may in fact have just the opposite effect. Philosophy and Research as we understand them, in reality, are not two sides of the same coin, combined to show us the validity of chiropractic, but rather can be compared to flipping that coin, each side representing a different objective. Prior to a football game the “coin toss” is not for the purpose of viewing two sides of the same coin in order to have a better understanding of a monetary system (who the system belongs to on one side and its denomination on the other) but to see who will first have the option to make a decision. The coin coming up “heads” is not a choice, an option or an alternative, a different way of looking at the same coin to give us more information but it, by its very nature and intent negates the other option or the other side exercising their option. “Heads” is really non-“tails.” It is not only a choice for what “heads” represents; it is a choice against whatever/whoever “tails” represents. Does research corroborate our philosophy? Does it attest to the truth, validity or accuracy of our philosophy? Does it support with evidence the chiropractic objective? Or does the very nature of research negate the need for and the validity of a philosophy of chiropractic? Conversely, does the philosophy of chiropractic negate the need for research…specifically that research that is intended to validate chiropractic’s ability to meet the medical objective? Do we engage in research in order to bring those who reject our philosophy into the fold when those who reject our philosophy would never embrace our approach to chiropractic to begin with? Is someone converted by the edge of the sword really a convert? If he is, it is only until another, a different sword, is held to their neck. How many people “lost their faith in chiropractic” in the early part of the last century when the medics ostensibly “proved” on cadavers that spinal bones do not move. Why has the chiropractic profession not done research in the past to prove our philosophy? Is it because we had no money and no confidence that research would support our philosophy, or that we had no way of doing research? Why did B.J. abandon his research of the effect of chiropractic on medical conditions? Perhaps it was because he realized research into medical conditions is a flawed model and chiropractic is not based upon a flawed model. Perhaps he understood that research belittles the true objective of chiropractic. When so-called legitimate chiropractic research began, our profession had just left the “chiropractic corrects the cause of all disease” phase and entered the “chiropractic gets some sick people well” phase, i.e., those with conditions that respond to our “natural” health care. On a video produced by the ICA, the traditional national chiropractic organization, chronicling Dr. Suh’s research, a well-known and well-respected leader of that organization said in effect that if research contradicted his philosophy, he would have to reevaluate his philosophy. This thinking set the tone for the chiropractic profession’s entry into the research field. In other words empirical findings trumped. When the chiropractic profession began to earnestly adopt and mimic medical practices, when they thought that performing medical procedures would gain them acceptance, the first thing they adopted was the medical procedure of diagnosis. It is what split the traditional and the objective straight chiropractors. The traditional straights adopted the medicalized model that required diagnosis and through controlling the accreditation process eventually all the schools were co-opted. Previously the early traditional chiropractors held to “subluxation as the cause of all disease.” That model does not require diagnosis. But it was not acceptable to the medical community, other chiropractors and the general public, at least not sufficiently to support a growing profession that desired acceptance. So the traditional chiropractic profession capitulated to the broad scope practitioners and merely disagreed on how many and which conditions chiropractic could and should address. But it does not matter whether your practice addresses one medical condition, 100 medical conditions or 1000 medical conditions, coming to a diagnostic conclusion is necessary. If we keep in mind that all chiropractors have at least one unified goal… to gain acceptance for the chiropractic profession,everyone would likely agree that acceptance or at least tolerance by the medical community is a prerequisite to acceptance by the general public. It was thought that by gaining the first (tolerance by the medical community) the second (acceptance by the public) would more easily come. After all it was almost universally thought that the bitter antagonism toward chiropractic by the medical profession was its biggest obstacle in gaining public acceptance. Their rejection of our foundational premise that chiropractic corrects the cause of DIS-EASE, mistakenly perceived as disease was the basis for that antagonism. The president of a chiropractic college at the centennial celebration of the profession implied that once we have demonstrated that our academic program meets acceptable standards and our diagnostic skills are approaching that of the medical community, it matters little which or how many conditions we address, just that we demonstrate by our research the effectiveness of our approach (outcomes assessment) for each of those diseases. Research seemed to be an answer, to satisfy the medical and scientific communities, the public and the entire chiropractic community, except for the small group of chiropractors who still maintained that chiropractic addresses the cause of all disease ( a few remaining traditional chiropractors) or no disease (all objective chiropractors). In the 60’s, chiropractors began to publish statistics of the percentages of patients who had positively responded to chiropractic care in the alleviation of their medical conditions. But these were only anecdotal, by individual chiropractors, published primarily in the form of advertisements that had little or no rigorous scientific or academic basis. This created a “need” and an opportunity for chiropractic institutions and organizations to enter into research, a place where it should logically be found. It also created an almost endless source of income, if medical research was any example, a source desperately needed by the schools to help subsidize their increased costs of education and a need to appear to be improving their standard of education and the profession’s standards as a whole. importunately, those standards had been set by the medical/scientific community and were focused on the treatment and cure of disease. To play their game we had to abide by their rules. This was the next step, wittingly or unwittingly, toward the medicalization of chiropractic. The question arises: Is the research model left over from a time when we, as a profession, held the philosophical position that while vertebral
subluxation is not the cause of all diseases, the correction of it gets some sick people (with some diseases). If we purport that research, for example, demonstrates that chiropractic is effective in 93% of the cases of XYZ condition, are we not saying that chiropractic as the “correction of vertebral subluxation to enable the forces of the innate intelligence of the body to be more fully expressed” is not effective in 7% of those cases? Further, does that contradict our chiropractic philosophical position that every time chiropractic is applied it enables the innate intelligence of the body’s forces to be more fully expressed as our principles imply. Are limitations of matter a legitimate principle or in the minds of the scientific community a convenient “chiropractic copout?” If they are not a copout, must we demonstrate what those limitations are? Can we hold to a philosophy on one hand and at the same time embrace a system that negates or calls into question the validity or importance of that philosophy? Chiropractic is based upon a priori assumptions; one is that the body responds in a certain manner every time an adjustment takes place. That does not mean that a medical condition in that particular body or any other body will respond in the same manner or that a medical condition in the same body will respond in the same or a similar manner tomorrow, next month or next year. Chiropractic, at least that practiced in the non-therapeutic model, is not subject to verification, corroboration, or falsification on the grounds of experience which is exactly what most research attempts to do. Some would argue in favor of “case studies.” However, these studies never evaluate any of the 7% who do not demonstrate positive results. If not, they are implying there is no 7% or that the 7% received substandard chiropractic care, i.e., malpractice. I would suggest that case studies may be effective as an advertisement, as they were originally used, to attract people with those Chiropractic and all endeavors that involve the human body should not be based upon experience and induction but rather on a priori assumptions. Chiropractic, except as an alternative to, or having the same objective as medicine is not subject to the same model of verification or falsification as medicine, on the ground of experience. Is that not exactly what Chiropractic is an a priori science, a science in which its principles can and must be given a rigorous logical justification. I believe that has been done and refined over the past 119 years. That distinguishes chiropractic from other so-called schools of healing. All others see themselves as empirical and consequently are dependent upon and validated or justified by the experience demonstrated by research. Chiropractic has long been denigrated because it has not used that empirical-experience-research model. It is true that historically we have not used it, not because our science is flawed but because the model itself is flawed. The principles of chiropractic beginning with the Major Premise and consisting of general observations which require no proof are accepted by nearly everyone hearing them because they are consistent with his or her prior thinking or observations. The most common response that a chiropractor hears after explaining the philosophy or objective is “that makes sense.” Should we embrace a model that is inherently flawed? conclusion Medical research or research into medical conditions within the practice of chiropractic is part of an outside-in philosophy, demonstrating the greatest good for the greatest number, with no consideration or recognition of an inborn intelligence as a vital component and consideration of the human organism and experience. If 93% of people in a group with XYZ disease are helped by a procedure, that means that 7% are either not helped and may in fact, have negative side-effects. That, according to medical philosophy, may be an acceptable number and even if some of the 7% die, that is acceptable “collateral damage.” After all 93% are being helped and that is the greater good for the greater number. By analogy, it is like Keynesian economics, the antagonist to Austrian economics that advocates “kicking the can down the road.” Spend money we don’t have in order to help the greater number now, even though we are leaving those who are not born yet (representing many more than just 7%) with debt they cannot repay.
Why did chiropractic not do research before? Was it insufficient finances, no confidence that it would support our philosophy, or perhaps because we had no way of doing it? It was likely that all three contributed. Today, as a profession, we have come to believe we have overcome or should overcome those obstacles. I would hope that our decision is not based upon
the assumption that research into medical conditions is a legitimate model with regard to chiropractic and that chiropractic can be based upon and evaluated by inadequate and flawed models. Research into medical conditions and chiropractic’s impact will reduce the value of chiropractic care by inferring that chiropractic is valuable for the limited number of conditions that have been researched and demonstrated to respond to chiropractic care in a certain percentage, at best. It does nothing to demonstrate the value of chiropractic care for all people, for a lifetime regardless of the presence or absence of a medical condition. Does research demonstrate that in the theoretical 7% of cases where people do not get well, chiropractic has failed or that the chiropractor has performed malpractice in that the chiropractor failed in his objective? Does any chiropractic research demonstrate that people with a medical condition who do not demonstrate improvement are still better off having subluxations corrected? Does chiropractic research into the alleviation of medical conditions/symptoms merely perpetuate the technique wars that have plagued our profession for the past 100 years? Chiropractic research is intended to be a benefit to the chiropractic profession, answering many of science’s, the government’s and the public’s questions. My fear is that is has raised more than it has answered. The purpose of this paper is not to denigrate research.
Research is valuable to chiropractic. But like chiropractic itself, research must be limited to the objective of chiropractic and any empirical aspects which may enhance and corroborate the narrow philosophy surrounding that objective. If not we will be one step closer to encroaching upon or being absorbed by the practice of medicine. As it is, our present research is not relevant to human beings. We cannot use physics, chemistry or anatomy to do our research. The whole methodology of modern empirical science is just not appropriate for researching the individual human body. If research is being done for the purpose of determining whether someone has had a successful experience under chiropractic care with XYZ disease, that research does not fit with our chiropractic principles and objective. Worst of all it raises another question: What does that have to do with chiropractic?