Chiropractic and its Role in the Health-Care Profession

 Introduction/Historical Background

Many in the chiropractic profession, including some of its leadership would like to move chiropractic further into the medical/therapeutic disease-treating model. They would like to see chiropractic travel the same route as the osteopaths, becoming part of the medical community. Their belief is that widespread acceptance will come with mainstreaming. Others, perhaps representing the largest group, see chiropractic as an alternative to medicine. Their model is couched in phrases like “correcting the cause of disease” and “drugless health care.” But their objective is “getting sick people well,” or preventing disease. Many in this group are adamant that adjusting subluxations is the only way to get sick people well. There is a third group that has emerged from this second group, one that is questioning chiropractic’s very involvement with health, whether we are or should be a health profession. In an effort to continually refine the philosophy and objective of the chiropractor and to make chiropractic more understandable and hence more attractive to the public, this group has been moving away from the health care model. These three groups are represented by schools, national organizations and state organizations, although the third group is more a fraternity of thought rather than an organized entity.

These three groups parallel the development of the chiropractic profession.^{(1) D.D. Palmer had a medical objective when he delivered a thrust to the spine of Harvey Lillard. His intention was to cure deafness.(2) After his success in the initial endeavor, the discoverer was convinced that he had a cure for a medical condition, that the cure was in the spine, replacing a displaced bone. It was a mechanical, therapeutic model that D.D. developed, at least in the beginning years. Early students of D.D.’s, like Solon M. Langworthy, became prominent practitioners, educators and researchers and further advanced the orthopedic model. Langworthy was listed in the Chicago directories as a “chiropractor and mechanopath.”(3)}

With the entrance of B.J. Palmer onto the chiropractic scene, the second group of chiropractors developed. B.J. saw chiropractic as a cure for the cause of all disease and he believed that the cause was located within the spine in the form of a vertebral subluxation. Chiropractic became an alternative to the treatment of disease. Within this second group an evolution took place as B.J.’s thinking changed over the years. Chiropractic was seen as an approach to health rather than an approach to disease (medicine) and that in the matter of getting sick people well, the restoration of health is an approach superior to the treatment of disease and its accompanying symptoms. The idea was that in restoring the integrity of the nerve system by correcting a subluxation, harmonious functions within the body were also restored and health was then restored. Further, disease was not really an entity to be addressed but merely a manifestation of a lack of health or EASE as he called it. Rather than fighting disease, the objective was to restore health or correct the cause of disease.

In the mid-seventies a change began to take place within the so-called straight chiropractic community that has given rise to the third group. Up to that point, straight had been defined by hands only and spine only, as opposed to mixing medical therapies with chiropractic. At Sherman College of Straight Chiropractic in Spartanburg, S.C., a movement began to define chiropractic by its objective. This philosophical direction was the result of the formation of the Council on Chiropractic Education (CCE) and its efforts to move the chiropractic profession in a medical direction. The issue at the time centered on diagnosis. The CCE maintained that the chiropractor needed to come to a medical conclusion and justify the need for chiropractic care to address that medical condition. President Thomas A. Gelardi and those associated with Sherman College argued that if we define chiropractic by its objective, then any procedure, whether of an analytical or administrative nature, should be consistent with meeting that objective. It is clear that diagnosis is consistent with the medical objective. It is equally clear that diagnosis is necessary for any type of health care which addresses disease or addresses people with a disease. If you are restoring health to a person with a disease, you must determine whether it is reasonable to expect that your health restoration will alleviate the effects of that disease, unless you view your care as the solution to all diseases. In that case, diagnosis would not be necessary. This position, however, is fraught with legal/malpractice problems and with public relations problems (holding yourself out to be a cure-all to the public). Any other position necessitates some degree of diagnostic skill and the question arises as to whether one can be competent with only a “degree of diagnostic skill.” It was at that point the straight chiropractic movement abandoned the idea of relating to disease and/or its cause altogether and moved to clearly define the chiropractic objective.

The Chiropractic Objective

While the chiropractic profession had historically related to disease in one way or another, a distillation of the practice of chiropractic as a separate, distinct and non-duplicating profession would require a unique objective that could not be confused with the practice of medicine as well as give governmental agencies and the public the rationale for its very existence. That uniqueness centers around the vertebral subluxation—a concept rejected by medicine, and the innate intelligence of the body, a concept ignored by the practice of medicine. It was therefore established that the chiropractic objective is to correct vertebral subluxations in order to enable the innate intelligence of the body to be more fully expressed. It was understood that this objective was to be applied to all people regardless of the presence or absence of a medical condition or the symptoms of a medical condition.

The Application of the Chiropractic Objective

to the Human Experience

Development and discussion of the chiropractic philosophy began to center around what the application of the chiropractic objective included and what it did not include. This was especially important in light of the trends in health care toward outcome assessment. With an understanding of the role of the innate intelligence with regard to the well being of the organism, it is clear that the adjustment to allow the innate intelligence to be more fully expressed affects nothing specifically, for example, disease to the point of making predictions of outcome. The idea of making no specific predictions or even looking for outcomes came about in part by accepting a more holistic approach to health and disease. If health (i.e., its acquisition and maintenance) involves many factors, then disease, a potential manifestation of a lack of health, would also involve many factors. This would reject the basic tenets of the practice of medicine holding to a single cause of each disease, an idea that was, in a modified form, adopted by early chiropractors. Medicine saw a single cause for each disease. Early chiropractors saw a single cause for all diseases. With the adoption of a more holistic philosophy of multiple factors rather than a single cause, the last vestiges of the “cause of all disease” concept in chiropractic were abandoned by the straight community.

The question arises as to what that leaves in the way of practical application of chiropractic care, especially in light of evaluating its participation or inclusion in health care. It is not the treatment of disease, its cause or cure, and if it is not addressing musculoskeletal conditions, does it fall into the category of health care at all?

Defining Health Care

The term health care is so broad, perhaps purposely so, that it encompasses almost every discipline that relates to human function. For this reason, the inclusion of chiropractic into the health care system creates confusion and blurs the distinctiveness of its unique approach. Although the practice of medicine is generally disease care in one way or another, it is found under the health care umbrella. The alternative practices to medicine (referred to as CAM) are usually directed at disease and yet are considered health care. Emotional, mental, and rehabilitative care are all considered a part of health care. While there are true approaches to health care that are proactive, i.e., approaches like exercise, hygiene and dietary activities, they represent a small part of the health care delivery system and very often they are practiced as disease treatment rather than true health care. Eating certain foods and avoiding others when done to treat or prevent a disease is really not health care but disease care. Exercising to rehabilitate from the effects of a disease, or to prevent a disease, is really not true health care. With all this confusion, the term health care has become meaningless. The term wellness care was coined late in the last century to attempt to clarify disease care from true health care, but has really only served as a euphemism for all the practices above, particularly in the area of disease prevention care. With all the foregoing in mind it seems that health care is pretty much a meaningless term in identifying a practice separate from disease care. Despite the optimism of some, there is little indication that the public’s preoccupation with disease treatment as the primary approach to health care is going to wane in the foreseeable future. The fact is, that apart from chiropractic, there is little thought given to and little to offer the public in the way of health care beyond the outside-in (therapeutic) model.

Chiropractic is Different Than Health Care

In addition to the argument that health care is dominated by and associated with the therapeutic model, an approach completely different from the straight chiropractic objective, the question arises as to whether chiropractic encompasses more than just health care. The idea of correcting vertebral subluxation to enable the innate intelligence to be more fully expressed clearly involves more of the human experience than just health. Although the term health can be defined in many ways to include almost everything involving human function and has been described as “1. The overall condition of an organism at a given time. 3. A condition of optimal well-being,”(4) it is generally associated with disease and its treatment or prevention. Chiropractic, at least since B.J.’s time, has historically positioned itself as addressing more than disease. Stephenson notes B.J.’s love for humanity and belief that the adjustment will create “an ideal sociological state…a country or a world without sickness, insanity, blindness, feeble-minded people, deaf and dumb, backward children, social evils, criminality, drunkenness, and its attendant evils, abnormal reproduction, etc.”(5)

The idea of correcting vertebral subluxation as something other than a health service was more than just a theoretical/philosophical exercise in the Green Books. Attempts were made to actively apply and practice the concept. In the early 1980’s, Reggie Gold, D.C. left the chiropractic profession and began Spinology®. While it used different language, its objective was to correct vertebral interference to the nerve system that impeded the body’s inborn ability to function at its maximum potential. It expressly avoided issues of health and diseases and its main focus was improving human potential.(6) One might say it was chiropractic without the health component.

Spinology® practitioners met with varied levels of success and when Reggie rejoined the straight chiropractic movement in the mid 1980’s, it was left without a leader. Anthony Tremain, D.C., an Australian, picked up on the title, if not the practice, and began teaching it in his country. As of this writing there is very little information as to the success of the practice. There is no indication that any of its practitioners have reached a level of success even close to that seen with successful straight chiropractic practices.

There is no doubt that chiropractic began as a health care profession. Spinology® was an attempt to address every aspect of function and performance except health. The above historical activities would present a case for chiropractic as more than health care. I would suggest that chiropractic is not health care, but neither is it more than health care. (See Figure 1) It is something different altogether, so different that it defies description and comparison to health care. It’s objective clearly defines its parameters. Its only purpose is to allow the innate intelligence of the body to be more fully expressed. This is of paramount importance whether or not someone is under professional care, being medically treated for a disease. It is equally important if they are doing nothing about a disease with which they have been diagnosed. That is the point. It is no more or no less important to have a subluxation corrected if you are medically treating a disease or simply ignoring the disease. The same holds true if you have no apparent or identified disease, whether you are addressing your health or ignoring your health. In any case, you still need a good nerve supply. The need to have subluxations corrected is based upon the need to have a good nerve supply, regardless of disease, health, performance, or anything else. The need for chiropractic is important for its own sake. Perhaps the closest similarity to the need for chiropractic is the need for rest. Your body needs rest for reparation and rejuvenation. It needs it whether you are fighting off a disease or not and whether you are seeking to be healthy or not. It is needed for its own sake. The analogy is not quite perfect, but close. At times you may need more sleep than other times. There are times when you may need more frequent adjustments. But you always need sleep to live! With regard to chiropractic care, you always need it when subluxated and you need it to live closer to the manner in which you were genetically intended to live.

Chiropractic Would be Better off

If Divorced From Health

The question arises as to whether the profession would be better accepted and placed in a more receptive light if it did not associate with health at all. There is no doubt that it would be better for chiropractic to be presented in a truthful manner, as exactly what it is, separate and distinct from the health field, separate and distinct from everything. Correcting vertebral subluxations to allow the innate intelligence of the body to be more fully expressed says nothing about health or anything else. It would also be better for the public if they realized the value of chiropractic care for life. As it is now, very few even see it as something for health. Most view it as a therapy for musculoskeletal problems, what Reggie Gold has referred to as “gutter chiropractic.”(7) This is chiropractic at its most basic level. Most chiropractors would be happy to see chiropractic taken to a different level, to be done for health’s sake or even for prevention. Most chiropractors themselves are adjusted for these reasons, seeing their chiropractor on a regular basis. This indicates that most chiropractors are not satisfied with chiropractic being viewed as just a treatment for backaches and stiff necks, for they themselves use it for something more. That alone would suggest that most chiropractors want chiropractic taken to a different level, at least to the second paradigm.(8) (*See Footnote) Chiropractic as a profession cannot survive as a treatment for musculoskeletal problems; there is too small a market and too many chiropractors, not to mention other professions such as physical therapy, osteopathy and physiatry, to compete with for that market. The chiropractic principle of correcting vertebral subluxations, regardless of health or sickness issues, would be served better if chiropractic was disassociated from the health field for chiropractic is something other than health care. The public would be better served if they had a clear understanding of chiropractic and utilized it for the right reasons, on a regular basis. Being subluxation-free for greater periods of time would have to improve the quality of people’s lives. Lastly, chiropractors would be better off if they could deliver chiropractic on that basis, not as a therapy or health care but as something you do for your life and well being. They would have a market as large as the population and as a result, more successful practices.

Marketing Chiropractic as Non-Health Care

There is no doubt that there is an enormous potential market for chiropractic in the non-therapeutic/non-health model. Every human being needs to have a spine free of nerve interference, hence needs to have his/her spine checked on a regular basis. However, it is only a potential market at this point, for the market still needs to be created. People need to understand the necessity of having their spines checked on a regular basis, not for back pain, not for disease care, not for health care, but simply because it is good for them. It will improve the quality of their lives. Therein lies part of the problem. What are we selling? We are not selling a cure. We are not selling prevention. We are not selling improved health. If we are selling improved performance and potential then we have merely embraced the Spinology® model. That is not bad, but it is a limited model, perhaps less limited than a health care model but also less attractive to the masses. People are more concerned about their health than they are shaving three strokes off their golf game. More people are concerned about not having a heart attack than they are reaching their potential in life, a rather nebulous goal. When asked what is most important in life, health is usually high on the list for most people. Very few people include “being all I can be!” on that list. Even if performance and potential were important to people, they are still outcomes. Chiropractic, as we would like to practice it, does not measure outcomes in cured diseases nor in decreased golf strokes. Further, no matter how many good outcomes we could honestly promote, i.e., better health, less sickness, better golf score, greater potential, we still would not even scratch the surface of the benefits of regular chiropractic. We simply have no idea how far reaching those benefits can be for any individual. That presents part of the problem of marketing this model. People are interested in the concrete. As much as they can grasp the idea of a better expression of innate intelligence, people prefer to know the tangible benefits and that those benefits are worth the time and money they are going to expend for chiropractic. In order to market chiropractic, at least to great numbers of people, we need to promise them more than “better innate expression” and do that without compromising the philosophy or our integrity. As a health profession we are able to do that. If we promise “improved health,” each individual can interpret that improvement in any way they want to or need to, i.e., relief, cure, less illness, longer life, or however they perceive better health. In all honesty, that is not how we would want people to view better health, but most people have their own criteria. Telling them differently does not change their mind. What is more, chiropractic often does result in relief, cure, less illness, longer life, etc. Making the benefits of chiropractic real, relevant, and tangible would seem to be the greatest difficulty in marketing this new model of chiropractic.

Straight chiropractors interested in embracing this new model are hesitant about doing any marketing in their communities for this reason. They are not sure what they can say that will be consistent with the non-health philosophy and will also be something to attract people to the office in sufficient numbers to at least offset the cost of the advertising. With little in the way of guidelines and no educational materials produced for the mass market, centered on a non-health approach, marketing this model is virtually impossible at this time. Getting people into the office is a major problem. Consequently, chiropractors are left to do essentially one-on-one presentations with the people that do enter their office. That is not bad, in fact it is probably the ideal way to educate, but it creates some other problems, which may be insurmountable for many chiropractors.

1. As mentioned before, the abstract concept of better innate intelligence expression is difficult for the chiropractor to explain.

2. That same abstract concept is even more difficult to explain for the practice member who you would like to have refer others into the office. Even in the most “health centered” practices a great percentage of those referred into the office are coming in with musculoskeletal conditions. It is much easier for the referring practice members to tell a friend with a back problem to see their chiropractor than to try to explain better innate expression to an asymptomatic friend who has an “if it ain’t broke don’t fix it” mentality. It is especially difficult inasmuch as some subluxations are accompanied by musculoskeletal symptoms and (unfortunately for a non-therapeutic approach) usually respond in a positive manner after a chiropractic adjustment.

3. As many as 50% of the people coming into a chiropractic office have already been to another chiropractor and almost all received an altogether different explanation of chiropractic. (9)

4. Because every other chiropractor in the community is advertising and practicing an altogether different model of chiropractic and it is the one understood by most of the public, the chiropractor must be either charismatic or forceful as well as an excellent communicator. Many straight chiropractors, especially those new in practice, are not.

5. The practitioner in practice for any length of time has the problem of trying to “convert” his already existing practice to a totally new way of thinking or else he will be running two practices.

6. The new practitioner is in some ways limiting his/her practice. Some potential practice members will not be looking for this type of care and will have to be turned away. The person who only wants back pain relief will not become a practice member. Even if the new practitioner could eventually build a practice of a non-health type, the problem is, with the increased education of chiropractors causing later graduation not to mention the high cost of student loans, the chiropractor may not have the time to build this type of practice.

Making the Transition to a Non-Health Profession

The above difficulties facing the chiropractor, whether new or veteran, raises the question as to whether chiropractors can make the transition on an individual basis and whether the straight chiropractic profession as a whole can make the transition from trying to be a health and wellness practice, in a disease oriented and therapeutically minded world, to the even more foreign concept to the public, i.e., getting adjusted for no other reason than increased innate intelligence expression. We have some history to give us insight into that. Spinology® attempted to make a transition in the public mind from disease/therapeutic/health care to potential/performance care. From all indications, they were not very successful in that endeavor. One might argue that the Spinologist® is not a fair comparison because they were beginning a totally unknown profession with no history. That might have been a handicap in changing people’s perception of the purpose of spinal adjustments but at the time the Spinologists® saw it as an asset, not carrying the therapeutic baggage of chiropractic. It would seem that the difficulty of each situation, beginning a new profession or transitioning one into a new model, would be equally difficult. The question remains, can chiropractors and the chiropractic profession make the transition.

Chiropractic is strongly entrenched in the therapeutic musculoskeletal model. As straight chiropractors we like to think that we practice outside that paradigm but in one way or another it affects every aspect of our practice. It is the reason why many, perhaps most, new people come into the office. Even good, regular practice members are often symptom-oriented. They and we are constantly exposed to outside-in thinking which has a subtle effect upon our world and life viewpoint.

It may well be that the average chiropractor cannot make the transition. Many chiropractors, new and those in practice for many years, have attempted to start out or turn their practice around and have not been able to achieve a totally “innate expression” type practice. There are a number of factors that would account for this. Some have been mentioned already, such as lack of educational materials and ability to clearly articulate the non-health model of chiropractic.

Another factor may be that currently there are no schools teaching this concept. There are no practice management consultants incorporating this model into their management program. In fact, almost every management consultant would likely discourage this type of practice because it would not utilize insurance, high fees, and would screen out those seeking therapeutic chiropractic. Unfortunately, more and more chiropractors are feeling the need to be associated with a practice management consultant, lessening the possibility that chiropractors and chiropractic can make the transition. There is no formal organization that promotes this type of practice which would create the environment for learning how to practice this way and also provide a support system necessary to help the chiropractor make the transition in his/her practice.

Without the concerted effort of a majority of the chiropractic profession, chiropractic will never make the transition from all that it is now to Reggie’s Third Paradigm. Most chiropractors are satisfied with the level on which they are practicing. They are making an adequate living and they believe they are providing a valuable service to the public, even if that service is treating bad backs and stiff necks. Those chiropractors not satisfied with their practice are usually dissatisfied with the income level that their practice provides. They are not candidates for a transition to a more difficult type of practice, and one that is probably not as financially rewarding.

There is a small minority, those that have somehow grasped the idea that chiropractic can provide something more than the public and even the majority of the chiropractic profession can imagine. These chiropractors will pursue this ideal for their practice, for their community and for the profession. Some of them can and will transition their lives and practice to some degree.

 

Conclusions

Chiropractic began as a health profession. It is practiced by a vast majority of the profession as a health profession. Some practice it as a treatment for disease, some as the correction of the cause of disease, and others as a means to restore health. All of these types of practices fall under the general heading of a health profession. Further, the government, both state and federal, recognizes chiropractic as a health profession. From a legal and precedence viewpoint, chiropractic is a health profession. However, this conference is designed to challenge our present thinking. Philosophically, chiropractic is not a health profession. It encompasses many areas of human function outside of health. Health has spread a wide net over the human experience, perhaps wider than it should, including disease treatment and prevention, health maintenance, and physical, mental, and social well-being. It has ventured into questionable areas, but even so there are vast areas of human activity that fall outside of health care which chiropractic affects. Chiropractic impacts so many areas, and in such a tangential and metaphysical manner, that it really cannot be considered part of anything whether human potential or health.

By analogy, studies have shown that people with strong spiritual beliefs tend to live longer than those who do not. Yet, that does not make religion health care. Other studies have indicated that people with pets live longer. That does not make my golden retriever a health care provider. Chiropractic impacts so many aspects of life, it cannot be pigeon-holed into any area. Chiropractic is not health care. However, chiropractic is almost universally practiced and accepted as health care. Can it be practiced differently? Can it be changed into a non-health care system? Without an almost universal effort by the profession, it certainly cannot be done. That universal effort will never occur as long as most chiropractors continue to choose to practice in a disease-treating, or medically-alternative care model. It would mean giving up health insurance, workman’s compensation and personal injury, and for all practical purposes, giving up the doctor image and avoiding the title. It would also take a monumental effort in public education. All chiropractic suppliers would have to destroy their current material. All practice management consultants would have to revamp their programs. All of this is highly unlikely in the foreseeable future. As much as we like to talk about the public moving in a drugless direction, the growth of the pharmaceutical industry and the illegal drug problem demonstrates that the public as a whole, especially the young people, do not have an aversion to drugs. Further, most people who reject the allopathic mindset and embrace “alternatives” accept drugless approaches which are still outside-in. Physical therapy, acupuncture, biofeedback, and the like are still therapeutic in nature. The medical procedures are not the problem. It is the outside-in philosophy that fosters them.

Sadly, giving up the health model is the only way that the chiropractic profession can grow and prosper. Already the competition of spinal manipulation is taking its toll as more and more non-chiropractic practitioners incorporate manipulation into their therapeutic model. As more and more new types of health care and approaches to getting sick people well (or at least covering up their symptoms) develop every year, the health care model of chiropractic will impact the community less and less. This obviously has a negative impact on our survival as a profession in the health model. Chiropractors may at the very least have to incorporate (mix) other health care approaches into their practice to keep their share of the health-oriented public. A quick glance at the telephone yellow pages shows that this is already happening as once straight chiropractors now incorporate things like massage and nutrition into their practices.

While the outlook for the profession as a whole may seem bleak, I believe that individual chiropractors who embrace a non-health model can succeed to a point. Without a concerted effort, by the entire profession, the challenge will be great, especially as more and more people are exposed to the disease and health models. Most chiropractors who want to practice a non-health model will probably have people coming into their office at different levels of understanding. Some people will come to have their subluxations corrected so that their body has a greater ability to heal itself. Others will come for adjustments so that they can reach a greater potential or to maintain health. Lastly, some will come for the right reason, simply because they want as full an expression of innate intelligence as possible, all the time. The individual chiropractor’s task will be to move the people coming into the office from one level to the next. Some chiropractors may choose to and actually may be able to see only people for the ultimate, third paradigm reason but the length of time required to build that type of practice will likely preclude many from doing it. People cannot be converted to this way of thinking overnight and most chiropractors beginning in practice cannot afford the starvation period necessary to screen out those not interested in this type of care.

Those chiropractors willing to make the effort to build this type of practice will face tremendous frustrations and challenge but the accomplishment of building this type of practice will be worth it. He or she will have the satisfaction of practicing chiropractic solely on its objective of improving the expression of the innate intelligence of the body. They will enjoy the reward of knowing that they are contributing to the survival of a principle greater than anything practiced within the health or disease care community and providing the most far-reaching chiropractic service possible, to as many people as possible.

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