Chiropractic journal article: adjustment of vertebral subluxation should be chiropractic’s distinct identity

Chiropractic journal article: adjustment of vertebral subluxation should be chiropractic’s distinct identity

A few months ago, Mark Crislip wrote a post over on SBM titled The New Chiropractic. And I thought SBM had an uphill battle. The post focused on the efforts of an Australian chiropractor, Bruce Walker, to promote the "new chiropractic," an evidence-based spine specialty that would eschew "all the pseudo-scientific baggage." Said baggage included, according Walker,

  • Adherence to a flawed chiropractic ideology centering on innate intelligence and vitalism.
  • Claims of cures for visceral and other non-musculo-skeletal conditions.
  • Use of the term "subluxation" as a valid diagnosis.
  • Life time chiropractic care in the name of "wellness."
  • An unhealthy disregard of clinical research, evidence based practice, and non-specific treatment effects including natural history and the placebo effect.

But, "for every chiropractor, there is an equal and opposite chiropractor." For the opposing view, we now have "Analysis and Adjustment of Vertebral Subluxation as a Separate and Distinct Identity for the Chiropractic Profession: A Commentary," just out from the Journal of Chiropractic Humanities,  which argues just what its title says: that chiropractic identity should focus on the very "pseudo-scientific baggage" bemoaned by Bruce Walker. The author is John Hart, DC, who is on the faculty of the Council on Chiropractic Education-accredited Sherman College of Chiropractic.

Hart notes that there is a lack of consensus regarding the identity of the chiropractic profession and that the public may be confused by the variability in viewpoints regarding just what chiropractic is and is not. Actually, the public doesn't seem confused at all. As Hart himself points out, the public sees chiropractors as back doctors. Only the chiropractors themselves are losing sleep over their identity.

Be that as it may, Hart argues that chiropractic should 

"base itself on its original intent, which is improving neurologic function by adjustments of vertebral subluxation."

The problems with this solution are immediately apparent to the more science-minded reader. First, chiropractors, after 120 years of trying, have never demonstrated that the vertebral subluxation exists. Two more complications follow from this one: if the subluxation doesn't exist, you can't find it, and if you can't find it, you can't adjust it. Finally, if it doesn't exist, and you can't find it, and can't adjust it, you're not going to be improving anyone's neurologic function.

These are the reasons, of course, that no other health care profession believes in the existence of the vertebral subluxation, its fabricated sequelae, or the necessity of its correction. But to Hart, this is the very reason chiropractors should seize the mantle of subluxation detection and correction: no one else is doing it. Don't get lost in the sea of practitioners (MDs, DOs, PTs, massage therapists) who treat back pain, he warns – be special!

Walker's disdain for "a flawed chiropractic ideology centering on innate intelligence and vitalism" is just what the doctor ordered, according to Hart:

"An identity having a focus on vertebral subluxation would also be consistent with the original intent of the founding of the chiropractic profession."

That founding, in 1895, was by a self-styled magnetic healer with no education or training in science who simply declared that the subluxation exists.

Hart himself admits to some of these problems, noting:

  • There are many definitions for the subluxation. (Hart's own definition is "a minor biomechanical dysfunction in the spine that results in a neurologic disturbance.")
  • Validity and reliability of methods used in subluxation detection is lacking.
  • Lack of evidence that the subluxation has any adverse effect on health.

He blows off the last one with the comment that just because "there may be only some evidence along those lines . . . it would be disingenuous to insinuate that there is none at all." He finds comfort in the fact that even subluxation naysayers in the chiropractic profession think the subluxation is a "legitimate, potentially testable, theoretical construct." Thus, Hart's argument is that somewhere between "theoretical construct" and "only some evidence along those lines" is a sufficient evidence base on which to lay the entire foundation of the chiropractic profession.

Hart perused the websites of chiropractic organizations and chiropractic colleges as well as surveys of the public, chiropractic students and chiropractors themselves. He finds support for his argument that the future of chiropractic lies in the vertebral subluxation in the fact that over 60% of chiropractic students think "the emphasis of chiropractic intervention is to eliminate vertebral subluxation complex." Almost 90% of practicing chiropractors, he notes, think the term "vertebral subluxation complex" should be retained.

Hart also says, incorrectly, that 31% of the public would like to use chiropractic care even if they were asymptomatic, indicating they are open to "maintenance care," another bankrupt chiropractic concept based on the detection and correction of phantom subluxations for "wellness." (It's not 31% of the public; it's 31% of the 12% of people who had seen a chiropractor in the last 5 years, according to the survey he references.)

Hart concludes that

"identifying the chiropractic profession with a focus on vertebral subluxation would give the profession uniqueness not duplicated by other health care professions and therefore might legitimize the existence of chiropractic as a health care profession."

Well, that hasn't worked for the last 120-plus years, but knock yourself out, Prof. Hart. 

Points of Interest 12/12/2016
Points of Interest 12/10/2016

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