Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Tuesday, October 12, 2004

Technique, Not Theory or Therapy

Technique, Not Theory or Therapy

Does the existence of a therapy justify its existence? No. It takes more than that. A form of therapy usually involves a combination of an underlying philosophy or theory and one or more special techniques. This combination of theory and technique may be unjustified. In fact, in certain cases it may even be advantageous to separate them.

In theory, it should be possible to separate the theory from the technique, but it is normally impossible to do so in practice. To illustrate, I’ll use a (false) homeopathic idea: The technique “remembers” its contact with the theory. The practice of a technique is contaminated by its history; both its theory and education. Therefore its practitioners are affected. They view things through colored glasses, and will tend to continue to use the technique in the same way, frequency and situations, even after they have renounced the original theory. This applies to DCs just as much as to any other type of alternative practitioner. It being a natural human reaction, it can even tend to happen among science-based personnel. The philosophical basis for a therapy is decisive for how much this tendency dominates.

If it is based on a religious/metaphysical idea, then reality is constantly being interpreted in such a way as to conform it to the theory. The theory can therefore be preserved for thousands of years more or less unchanged. This passage of time is often used as an argument for the truthfulness of the theory, but the passage of time does not make truth error, nor error truth. This accounts for the unchanged nature of such therapies as acupuncture, homeopathy, etc. There is no acceptance of new knowledge that goes contrary to the accepted theory. There is no accountability to an objective standard of evidence or truth. Subjective standards are considered proof enough. Thus an unhealthy state of stability is maintained.

If it is science-based, then the theory may undergo many changes, being forced to do so by the constant confrontation with new knowledge about reality. Thus the theory becomes a more and more accurate way of describing reality. It becomes more trustworthy. Belief gives way to knowledge. This explains the seeming uncertainty in scientific circles. Likewise the constant abandonment of earlier held ideas. This instability is a healthy sign, as it indicates growth, accountability to an objective standard and quality control. (Many practitioners of so-called "alternative medicine" - including some chiropractors - do not understand this and use it as an argument against science and for their unproven methods.)

This illustrates well that which is expressed in the Danish word for science: “videnskab”. This word is a combination of two words, “viden”, meaning “knowledge”, and “skab”, meaning “create”. To a Dane, science means “to create knowledge”, and true knowledge, that can be relied on, is constantly updated. Theories are subjected to criticism and then reevaluated. To “know” is more than to “believe”. Hypotheses get tested, and then get rejected or accepted. If accepted, they are no longer in the realm of belief, but are scientific fact. Now we “know”.

Acupuncture can be used to illustrate. It is not necessary to accept “acupuncture” - as a word, profession or theory - in order to possibly accept the use of needles as a legitimate form of pain treatment, since neither its theories regarding disease nor its acupuncture “points” and “meridians”, have any validity. It is most likely totally different mechanisms that can explain any possible effect in some situations. The value of any possible effect, as compared to standard analgesics, can certainly still be discussed.

Just as with acupuncture, “chiropractic” and “adjustment”, as a profession and as words, do not deserve recognition. That is no hindrance for the acceptance of manipulation where useful. The point of this is, that one technique does not legitimize a whole profession and that a fundamentally false theory, when used as the foundation, nullifies the right to existence of a profession and, preferably, its terminology.

Words are associated with their developmental history and philosophy. Why dignify quackish ideas by adopting the terminology associated with it, especially since these terms imply untruths? The use of the very inaccurate expression “slipped disc” in ordinary speech, instead of the more accurate “herniated disc”, is a good example. Chiropractors have capitalized on this misnomer for years, indoctrinating (brainwashing) their patients into believing that chiropractors could push it back in place again.

Chiropractic patients often believe that when the back is "out of alignment" it is out of joint - the dreaded BOOP (bone out of place). That cannot happen without a fracture or severe joint destruction (and then manipulation/adjustment would be absolutely contraindicated). It is most likely tense and/or cramped muscles that are pulling it “crooked” (temporary scoliosis). If the muscles are treated with warmth, massage and stretching, and often combined with the use of joint mobilization - presto, the back is now “aligned” again. (Not that it ever was out of "alignment.") Thus there is usually little or no need for manipulation/adjustment.

A reform chiropractor has written:

“Crelin showed that one of the bedrock principles of chiropractic - the hypothesis that the vertebral pinching of spinal nerves impairs nerve functioning - is almost certainly invalid. Chiro-practic without this principle is analogous to meridianless acu-puncture.” Craig F. Nelson, DC

Craig Nelson could not have chosen a better analogy. Acupuncture “points”, “meridians”, and “chiropractic subluxations” have this in common: they do not exist as physical, biological entities, but are metaphysical beliefs. Their existence has never been proven. They are fantasies.

Acupuncture without the philosophy is needling. Manipulation without the philosophy isn't adjustment. Chiropractic without subluxations isn't chiropractic. Call it something else. But the word "chiropractic" is too loaded with negative meaning to be useful anymore. Historically, philosophically, scientifically, ethically, and politically, it is a witches' brew of a biotheological cult.