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, November 30, 2004

In the Quest for Cultural Authority

Dynamic Chiropractic
December 16, 2004, Volume 22, Issue 26

In the Quest for Cultural Authority

by Joseph C. Keating Jr., PhD; Thomas E. Hyde, DC, DACBSP; J. Michael Menke, MA, DC; David Seaman, DC; Richard E. Vincent, DC; and Larry H. Wyatt, DC, DACBR

Problem Statement

Chiropractors yearn for greater respect and acceptance from the public, health care policy-makers and other professionals. To achieve this goal (i.e., cultural authority), DCs must first build good faith with these constituencies by developing higher standards of professional behavior, including adoption of a scientific epistemology, commitment to evidence-informed practice and accountability, frankness and balance in public relations and marketing, and a much-expanded course of rigorous scientific investigations. Indeed, this last point is an ethical mandate for any profession: to critically assess and share its clinical gifts with the rest of world.1
We believe that one of the most significant barriers to the development of "cultural authority"2 for DCs is our traditional dedication to a scientifically unsubstantiated (and largely untested) construct: the subluxation. Exemplary of this steadfast adherence to an unproved theory are the declarations concerning subluxation issued by the Association of Chiropractic Colleges (ACC) in its 1996 position paper.3 Comprised of the various presidents and deans of North American chiropractic schools, the ACC defined the profession in terms of its orientation to the traditional "chiropractic lesion." Popularly known as the ACC Paradigm, the position paper and its subluxation definition were "constructed by a process of consensus to serve as a collective political statement, not a research hypothesis."4 The intended purpose of the ACC Paradigm, as we understand it, was to foster greater unity in our historically divided profession. In this respect, we suppose, it has accomplished its purpose to some extent. In the years since, the document has been endorsed by a number of national and international organizations, including the American Chiropractic Association, the International Chiropractors' Association and the World Federation of Chiropractic.

Unfortunately, the statements concerning subluxation offered by the ACC conflict with commonly accepted scientific standards, and function to diminish the credibility of the profession. Although spinal manipulation has enjoyed some considerable success in controlled outcome studies and reviews of its usefulness for patients with low back pain (LBP),5-7 neither the cause(s) of LBP nor the mechanism(s) of its relief by adjusting are well-established.8 Evidence of the value of spinal manipulation for problems other than LBP is less extensive,9-10 and the role that subluxation (or other forms of joint dysfunction) may play in causing and/or providing relief through adjusting is uncertain. Accordingly, we believe that the ACC's assertions concerning subluxation, however well-intended, lack scientific credibility and play a significant role in preventing the profession from reaching its full potential as a credible health care art and science.

The ACC Paradigm statements concerning subluxation typify the scientifically unjustified assertions made throughout the profession.11-14 We believe that persecution and professional ostracism are the inevitable consequences of the currently indefensible clinical and physiological theories propounded by many DCs as core tenets (i.e., a priori truths or "principles"). We propose that a significant "rethink" is in order. . . .

We bring much of this ridicule upon ourselves, knowingly or unwittingly, by what we say to one another and how we portray ourselves to the public we serve. The authors are not so naïve as to suggest that interprofessional turf protection, allopathic arrogance and economic competition do not also enter into the equation. However, it does seem that a great many of the bullets aimed at us are of our own manufacturing. Much of this ammunition derives from our lack of restraint in making claims for the chiropractic healing art.

(There's more)

(Emphasis - PL)


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