You Should Revise Your Work and
Change the Rhetoric Used to a More Neutral Tone
January 18, 2010
It is with great ambivalence that I write to you. On one hand, after viewing your website for the past several years, it is hard to accept the blatant prejudice against chiropractic that you espouse. But on the other hand.........wait, here it comes............thank-you?
Not for the biased, unilateral view that you give, but for pointing out the overt discrepancies that abound in our profession. It is of great importance that we accept criticism in its most basic forms because this creates an environment of checks and balances, which, in due time, will strengthen our profession and ensure its viability in the future to come.
I have been a chiropractor for 6 years after completing my studies at New York Chiropractic College. I am in private practice with my wife and one other staff member, and we have designed our practice around an evidence-based, conservative therapy practice that promotes wellness-care and musculoskeletal therapy. We have a good reputation not only within the community, but with other allopathic physicians based locally. I tell you this only to avoid the assumption that I'm representative of the "quackery" you find so repulsive.
For all intensive purposes, I am what would be considered a "mixer" chiropractor, though I find the "straight vs. mixer" terminology to be pointless and divisive. There is no need to create a division in our profession based on this principle; clarification and education will do much better long-term towards creating a strong chiropractic institution that is accepted universally.
My reason for writing to you is that after several years of reading your material, I have come to the conclusion that you are not necessarily destructive to the chiropractic profession, but rather better used as a reference point when determining that proper path our profession needs to take. While I find many faults within the arguments you propose here, and much of your material against chiropractic is based upon notions that you have taken widely out-of-context, you still have given us the benefit of constructive criticism. I do not believe your intentions are always honorable, nor can you argue that this is all created entirely for the advancement of our profession, but you raise many legitimate talking points that need to have serious review within our ranks. So thank-you.
However, I would like to take this opportunity to raise some talking points of my own.
First of all, as a profession research is needed to further advance our position. I was intrigued by the article by Craig F. Nelson, "Views of a Reformist Chiropractor." He presented a rational argument about CMT and research. While it has been long known that we need to conduct proper studies for chiropractic, you conveniently neglect to add that we still make up less than 4% of the NIH annual budget for research. It begs the question that if the committees that allocate resources from these institutions are mostly allopathic doctors, then is there a systemic bias against awarding the grant money for chiropractic research in the first place? After 115 years of overt oppression, and from my own experiences, I find it hard to believe that the medical community would sponsor research to validate the very profession that stands to remove vast sums of health-care dollars from the mainstream professions, especially since back pain is second only to respiratory infections as the leading cause of doctor visits. You may find this a knee-jerk reaction, but don't you agree that if given the proper funding, the chiropractic community would jump at the chance to conduct legitimate research? The results of research- good or bad- are frequently disseminated through numerous trade publications, as is the call for more private funding and support.
The entire premise of your website is to expose the discrepancies and falsehoods within chiropractic. Granted, many of your points are valid, but why do you feel it is necessary to provide this material in a belligerent, slanted manner? I believe you would have much more support from our profession if your articles were written in a more objective manner. My biggest concern is that while you certainly have gone to great lengths to understand the more dubious aspects of chiropractic, how come you deliberately choose to ignore or underestimate the positive aspects of many of these same techniques/protocols, or exclude them altogether? There are many, many benevolent, legitimate aspects about chiropractic that are widely used today by conservative, ethical doctors. I find fault with Dr. Homola in that his support of chiropractic is derived from an extremely narrow view of the scope of chiropractic. Both Dr. Homola and yourself frequently entertain the idea that chiropractors ought to be subservient to allopathic doctors, much like physical therapy is today. But this notion defies the efforts of many generations of chiropractors to elevate our educational requirements in order to have independence from the allopathic community. Given the basic, philosophical differences between our professions, chiropractic is not interested in being absorbed by the medical field, following the path of osteopathy.
Your website frequently undermines and refutes the importance of nutrition in health-care. I do not find this surprising, as the allopathic field has effectively abandoned the intrinsic role of nutrition in favor of the more profitable pharmacological route. If any doctor cannot fathom the importance of diet and exercise in preventing disease and disability, then I suggest they choose another profession. You imply that chiropractors are not qualified to disperse nutritional education to their patients, but forget to mention that the chiropractic colleges offer more nutritional courses in the core curriculum than medical schools. If we know that certain diseases are precipitated by the lack of nutrition, then why is it difficult to understand that subclinical nutritional deficiencies also create circumstances of suboptimal health, and can therefore be alleviated through simple supplementation? This is a gigantic hypocritical element within the medical community that has not been lost on society. Many patients frequently complain about the near-constant barrage of pharmaceuticals that are given by doctors, with almost no discussion of less-invasive measures. This is one of the reasons patients give when requesting nutritional advice from our office.
While the issue of strokes following manipulation is a grave concern within our profession, you fail to mention that it is no more prevalent in chiropractic than in osteopathy, physical therapy, massage, etc, when given in proportion. While I would argue that chiropractors are likely the most qualified practitioners of manipulation (given the simple aspect that we perform the vast majority of manipulative treatments), rates of injuries are similar regardless of which type of practitioner is performing the technique. So then why is it that your website only chooses to persecute chiropractic on this matter without presenting the whole picture? We know that many medical treatments have a far greater incidence of injury, so why is it you choose to not include fair neutrality on this issue?
Which brings me to my next point—Where is the objectivity and neutrality on your Jeers and Cheers page? No doubt your website has evoked many emotional responses to your articles, but it is obvious to the viewer that you have cherry-picked the opposing responses based upon your liking. A professional mediator of information would exclude the obnoxious, sophomoric responses you receive, and only print the responses that are well-written and thought-provoking. In attempting to spotlight the unprofessional knee-jerk attitude of many of your livid readers, you only prove the theory that your goal is not to strengthen the chiropractic profession, but to dissuade people from ever seeking out the potential benefits they may desperately need.
Lastly, the "subluxation" issue. We agree on one thing at least- Chiropractic is not and never will be the panacea of health-care cure-alls—The very same thing can be said of the allopathic profession. I do not use the term "subluxation" in my practice because I find it archaic and confusing. I can readily inform the patient of their musculoskeletal condition with sound physiological explanations (presented in lay terms, of course) in a much more efficient manner. But what about the subluxation? What is it? Does it even exist? What are the consequences of spinal subluxations?- Well, the answer to this depends on the view of the individual. Like you, I also find the notion of a "bone out of place, pressing on a nerve, causing visceral disease" to be far-fetched. Fortunately, NYCC does not teach this model in favor of a more scientific physiological approach. I agree that it seems silly to promote the idea that subluxations (I'm getting tired of typing this word!) can be found on x-ray. Again, NYCC does not teach this, I know other schools do, however. But if your definition of a subluxation is a joint segment (spinal or otherwise) that is restricted in motion, inflamed, and causing a pain syndrome, then simple palpation is warranted. You website doesn't even afford chiropractors the ability to find malfunctioning vertebral segments through palpation. But this notion is also untrue; many medical doctors must palpate a patient when assessing visceral complaints (such as liver disease, prostate disease, impaction, etc.) Obviously the medical doctors are qualified to discern medical complaints with palpation, why is a chiropractor who palpates the spine for similar pathology not qualified in your opinion?
The other aspect of the subluxation is the "straight" model that our profession originally promoted in its infancy. I find the debate to be more about the assumptions that are made with subluxation, not whether or not they actually exist. In other words, maybe the problem is what our profession claims it can do, rather than the exact definition. It seems our profession is always trying to put the cart before the horse; changing the model of subluxation to fit the notions, rather than prove/disprove the basic theory. I find it aggravating that many of my colleagues choose to believe in the idea that subluxations are the cause of all ailments, when this idea is fraught with discrepancies and falsehoods. I do support the idea that a physiological insult to a particular nerve, resulting in reduced function of that nerve, can cause a detrimental effect to the endpoint tissue. This can be easily reproduced in animal studies. Logic would therefore support the idea that a return of proper function of that nerve may allow a subsequent return of endpoint function. Period. The problem we face is when claims are made pre-emptively and universally. While I have personally experienced in practice many wonderful non-musculoskeletal improvements that appear to have been directly correlated with a recent manipulation, common sense states that I cannot reasonably pre-qualify any patient as to the expected results. So, while it can be reasonably conjectured that chiropractic MAY help with certain non-MS conditions, the fault we face is in making unsupported claims, not the very idea itself. My argument with you, Dr. Barrett, is that you choose to dismiss the physiological theory altogether, instead of only debating the unsubstantiated claims that are made by "straight" members of our profession.
I hope you accept my criticism in earnest, as I have attempted to do with your writings.
I ask that you revise your work and change the rhetoric used to a more neutral tone. You may make the same points, but with more tactfulness you will find a large number of chiropractors will support you in your work. A certain level of skepticism and critique can be a productive effort, to avoid doing so professionally defeats the very purpose of it.
I give my permission to post this letter on your website, so long as it is printed in its entirety and without alteration.
Thank-you for taking the time to address my concerns.