Table of Contents ||| Chirobase Home Page
- In the last analysis, we see only what we are ready to see, what we have been taught to see. We eliminate and ignore everything that is not part of our prejudices.
- JEAN MARTIN CHARCOT
Although there clearly seems to be a need for drastic changes in the aims and policies of chiropractic activity, and an even greater need for specialized development of manipulative services on a level cooperative with medical practice, there are few indications that either are in the making at the present time -- at least as far as chiropractic is concerned. As we brought out earlier, the ultimate fate of the chiropractic profession -- whether specialization, change, or extinction -- can be determined only in time and observation. That some change will take place is, in my opinion, inevitable, for no healing art could expect to treat human disease properly without the cooperation and reciprocity of accredited specialties and hospitals. In addition, too long a separation from the main stream of science would prove fatal to the survival of any freshly budding science.
There seems to be little question -- at the present time -- that there is little or no justification (in standards or in methods) for the chiropractic treatment of infectious and organic disease in competition with medical practice. On the other hand, it also appears that there is an unfilled need for manipulative services in the routine course of medical practice. If elevation and specialization of chiropractic does not fill this gap in time to come, I have little doubt that medically-trained technicians, working under the prescription of medical practitioners, will automatically move in and provide this service as manipulation becomes better established as a science. As we noted several times throughout this book, this is a movement that has apparently already begun. In any event, if the chiropractic profession fails to make the changes necessary for recognition in the assumption of its chosen responsibilities, there seems to be every possibility that it will gradually die as a second-rate medical practice, in spite of the fact that many individual chiropractors now offer manipulative services of definite value. In overall observation, and according to the definition of chiropractic, there seems to be little doubt that chiropractic now claims to offer a superior method in the treatment of most disease claims that are quite anomalous in view of the fact that they are underlined with a single treatment method.
The problems of difference besetting the chiropractic and medical professions are no doubt setting a precedent in the history of medicine -- problems that present an interesting and fantastic study of a unique and peculiar situation.
Although the Haynes-Stanford study (Chiropractic in California) -- made by the Haynes Foundation and the Stanford Research Institute of California -- was confined to a study of chiropractic in the State of California, the conclusions of this study are remarkably similar to conclusions drawn from time to time throughout this book (concerning chiropractic as a whole in all states) . Since California has more licensed and practicing chiropractors than any other single state, the conclusions of the Haynes-Stanford study are particularly significant in speculating upon the future of chiropractic in the nation. Chiropractic in California differs from that in a great many states in that it leans heavily toward medical methods of practice and less towards the strict use of fundamental chiropractic. Considering the history of osteopathy and the nature of the fundamental chiropractic concept, many look upon chiropractic in California as being somewhat more advanced than chiropractic in most states.
For a summary of the Haynes-Stanford study, released by the Haynes Foundation in July of 1960, the following quotations have been taken from the "Summary and Conclusions" of that report:
ON THE BASIS OF THIS RESEARCH, WHAT APPEARS TO BE THE FUTURE OUTLOOK FOR CHIROPRACTIC IN CALIFORNIA?
Four fundamental characteristics of chiropractic arising from this research serve as the basis for an answer to this question. These characteristics are as follows:
1.The number of chiropractic practitioners and students is declining.
2. Chiropractors, although comprising the second largest group of healers, serve less than one-thirtieth of the market for healing services. On the basis of a statewide survey, of all conditions attended by chiropractors, osteopaths, and medical doctors (excluding those of hospital inpatients), 3.6% were seen by chiropractors, 9.3% by osteopaths, and 87% by medical doctors. Thus, practicing chiropractors, comprising 16% of all California doctors, attended 3.6% of all reported conditions; osteopaths, comprising 9% of all doctors, attended 9.3% of all conditions; and medical doctors, comprising 75% of all doctors, attended 87% of all conditions. Therefore, chiropractors were found to have the lowest rate of utilization among California doctors. (41-C)
3. There is a high degree of internal dissension among chiropractors.
4. Chiropractic education has not succeeded in obtaining support from its own practitioners, from its friends, or from governmental sources.
These factors, although negative in their nature, constitute the basic framework of chiropractic in California. The positive aspects of chiropractic, such as the sincerity of many of its practitioners, are likely to have a lesser degree of influence on the future course of the profession. With the foregoing factors in mind, there are several long-range developmental possibilities to consider. The range of these possibilities includes:
1. The emergence of the "straights" as a specialized health field, such as dentistry or psychiatry.
2. The emergence of the "mixers" as medical men -- "chiropractic physicians and surgeons."
3. The general continued decline of chiropractic as a profession in its present form.
The first of these possibilities would require that the "straights" somehow unite their forces to reverse the present trend toward "mixer" dominance. It also assumes that organized medicine would recognize the "straight" chiropractic approach as a necessary and valuable addition to medicine, and that the "straights" could agree among themselves on this approach. Both assumptions appear to be improbable. Within chiropractic, the "straights" are weak, just as the "straight" osteopath was weak a decade ago. Moreover, organized medicine has not indicated an interest in "straight" chiropractic. Rather, it has chosen to support the growth and development of physiotherapy as a profession.
The second of the possibilities suggests that the chiropractic mixer" can follow the same historical course as his osteopathic counterpart. To do so the "mixers" must, first, break free of the chiropractic "straights" and, second, gain the financial, legal, and public support necessary to upgrade their medical training. The first of these requirements appears to be a logical possibility perhaps within the next decade or two. However, it is questionable whether the second requirement can be achieved. Medicine, since its massive reorganization in the early part of this century, has gained a strong position in the healing arts and in public opinion. It is today in a much stronger, more popular position than it was at the time osteopathy moved into the field of medicine. Thus, it is reasonable to conclude that chiropractic would be faced with a more difficult task than was osteopathy in seeking a place in the medical arts.
On the basis of this research, the third possibility appears to be the most realistic. To become a part of modern medicine, chiropractic would have to compete, in essence, with the well established medical institutions. However, chiropractors and chiropractic students are declining in number. Within the institution itself there is a conflict of philosophy and a struggle for control. Furthermore, the schools are in financial difficulty with no apparent relief in sight. These facts suggest that chiropractic does not have the strength to compete more successfully than it has in the past in a field (the healing arts) which is generally characterized by an increasing degree of scientific approach, greater financial investment, and higher standards of practice .
Thus, the problems besetting the chiropractic profession in its drive for recognition are enormous. There is, on one hand, simply the definition of chiropractic to contend with -- a definition not yet accepted by a single scientific or educational institution within the continental United States, notwithstanding the fact that it is legally licensed in 46 of these states. As a result of the legal definition of chiropractic in various state statutes, other problems, for all concerned, are created in direct proportion to the progress of a changing society.
Paradoxically, the uniqueness of the chiropractic theory, while providing the chiropractic profession with its only reason for an independent existence, now threatens the profession with extinction. Chiropractors now find themselves faced with an alternative of three almost impossible decisions:
(1) One is deciding whether or not the doctrine of chiropractic is valid in its fundamental aspects, and whether or not the chiropractor is qualified to act according to a decision either way -- that is, to continue to treat disease according to the chiropractic theory (necessitating continued competition with medical practice) or to add medical treatment methods in admission of the falsehoods underlying the creed of D. D. Palmer. Although adherence to the fundamental chiropractic theory seems to be the profession's only hold on legal licensure at the present time, failure to change this definition might ultimately result in the failure of the profession to survive.
(2) Another alternative is making the necessary changes to warrant scientific and academic support as a separate system of healing. Unless the chiropractic theory proved to be correct -- and this does not seem likely over the broad scope of disease -- support for the chiropractic profession as a method of healing in competition with medical practice will hardly be forthcoming, thus making it impossible to upgrade the chiropractic schools and hospitals to equal those training medical practitioners.
(3) Finally, as we have suggested several times, one logical solution to the chiropractic dilemma might be found in chiropractic specialization in the realm of physical treatment, in cooperation with medical practice (according to the general guides of medical science), which, of course, would necessitate subordination to medical practice. This, however, raises many other problems that have already been discussed in this book. At the present time, most chiropractors are of the firm opinion that chiropractic is not only adequate as a method of healing as opposed to the practice of medicine but is also quite superior to the practice of medicine.
Thus, it becomes apparent that, regardless of the opposition of medical science to the practice of chiropractic (as a method of treating disease), the main trouble with chiropractic is chiropractic itself. Whatever might be correct in the use of manipulation is obviously not uniformly pursued by chiropractors. Furthermore, there do not seem to be any authorities within the realm of chiropractic with enough influence to successfully unite the various factions in chiropractic on factual and common grounds.
Establishment of chiropractic as a science would, of necessity, demand that chiropractors themselves clean and unite their own organization according to facts and standards characteristic of any recognized science in the healing arts, even if it meant rejection of a great deal of what has been traditionally known as chiropractic.
Since there is a great deal of value in the use of spinal manipulation in the treatment of selected spinal disorders, and since such treatment is not yet widely available in medical practice, there is undoubtedly a need for the services of the chiropractor who limits his practice to such treatment. Unless the chiropractic profession as a whole specializes in the physical treatment of back disorders, however, and earns reciprocity with other healing professions, under the guidance of medical science, there will be no justification for the existence of chiropractic when an adequate number of medical specialists and medical technicians make scientific manipulation available in a department of medical practice.
Appendix A ||| Table
Chirobase Home Page