Chiropractic diversity: strength or threat?

Doug Pooley
February 05, 2019
Written by Doug Pooley
Reason (verb) "The power of comprehending, inferring, or thinking especially in orderly rational ways"
The alleged diversity of the chiropractic profession has come under public scrutiny. An article published in November 2018 in The Globe & Mail intimated that there's a perverse dichotomy that exists within chiropractic, elements of which may be a threat to the consumer.

Within the article, the authors, who claim to have done exhaustive research on the profession, curiously chose to direct their focus on the current and past leadership of the College of Chiropractors of Ontario. They state that these individuals have made claims either in person or through their social media that fall outside the scope of our profession, or are not substantiated by reasonable scientific study. Then, to verify their assertions sought out members within our profession who were willing to lend support to their claims. They used the labels "vitalists" vs. "evidence-based" to portray the profession as fractured and intimate that we are not much more than a bunch of unethical snake-oil peddlers who lack the professionalism to self-govern. Even as a seasoned practitioner the arguments and details they presented made me pause. But before we concede to that end, perhaps we should look at the scenario through the eyes of reason.

No one gets up one morning and suddenly decides that they are going to tear down a health profession regulator. That is just not logical, so we can with a certain level of probability assume that somewhere along the path there emerged a bias. For that bias to have enough weight to make it newsworthy, logic again dictates that it came from a disgruntled party or parties, probably from within chiropractic. Then, they attempted to substantiate the bias by the gathering of supportive evidence from within the profession. By picking and choosing examples and circumstance to justify their case, they have painted chiropractic as belonging to one of two camps, "vitalist" or "evidence-based," both of which in their purest forms could be considered outliers.

Having been in practice for over 40 years, served on various boards, and interacted with hundreds of fellow chiropractors over that period of time, I have to say that yes, this profession does have outliers at both ends, and both can be equally dangerous. Every profession has idealists and in many ways one end of the spectrum serves to stimulate growth and new ideas and the other as the conscience to ground us in what has been substantiated. The middle, which by far represents the majority of practitioners, moderates both ends. Here is where you find the true voice of reason. It is here that the truth of a profession can be found, in the average practitioner who goes to work, genuinely has the best interests of their patients at heart and practices competently within the standards of practice that define our profession. Having sat both on the CCO committees as well as the council, I can assure you that the same holds true here. Both ends of the spectrum are present, but by far the majority of the members are reasoned, hard working and representative of what is good in the profession. It is made up of professional representation as well as members of the public. It upholds the standards of practice, which are for the most part common to all of the health disciplines and is first and foremost fair in its mandate to protect the public. The attempts by the author to paint the College of Chiropractors of Ontario as otherwise are just not the truth.

Truth (noun) "A fact or belief that is accepted as true."
The authors of The Globe & Mail article go on to imply that the chiropractic treatment of children is inappropriate and dangerous. They again use the random actions of outliers to create doubt and justify their bias. The truth is that children are human beings just like adults who sometimes hurt themselves and require chiropractic care. Even a cursory understanding of functional biomechanics demonstrates that mechanical distortions in the spine and related weight-bearing joints left over time will alter mobility and eventually predispose associated articulations and soft tissues to weakness and strain. What is illogical is a belief that children possess some magical recuperative capacity different than adults that make them immune to mechanical injury. In fact, if they were truly interested in protecting "our most precious resource" then pressure the government to mandate standardized posture and mobility testing for school-aged children to identify and correct mechanical distortions prior to them manifesting as potentially lifelong clinical concerns.

Now, let's tackle an uncomfortable truth: Whether you are a vitalist or a mechanist, evidence-based or idealist, there's an acknowledgment that there is an organizing intelligence to life. That energy/force may have different names such as spirit, prana, universal intelligence, God-force , Chi or innate, depending on your background. Science, since the beginning of time has looked to identify the source of that energy and to date it still mystifies. You give the right medicine to a live body and it responds. You give that same medicine to a dead body and there is just not much happening. Here is where it gets interesting: If you give the right medicine to a sick body, does that medicine/treatment influence that life energy? Of course it does – the body responds and thrives. In chiropractic, the term used by many to identify this energy is "innate." It is just a term, and for the very same reasons that medicine works, chiropractic treatment has the capacity to influence that energy.

Reality (noun) "Reality is the sum or aggregate of all that is real or existent, as opposed to that which is merely imaginary."
Lastly, lets uncover the elephant in the room – the term subluxation. The authors in the article state: "There's no evidence subluxations exist." The term subluxation is a uniquely chiropractic term in its reference to the spine. According to Steven G. Yeomans in a 2009 article in the peer reviewed website spine-health.com, "the term 'subluxation' is used by doctors of chiropractic to depict the altered position of the vertebra and subsequent functional loss, which determines the location for the spinal manipulation. 'Subluxation' has been defined medically as '...a partial abnormal separation of the articular surfaces of a joint.'

Chiropractors have described the term to include a complex of functions (i.e., the subluxation complex) as "...an alteration of the biomechanical and physiological dynamics of contiguous structures which can cause neural disturbances."

The word subluxation is in fact an excellent descriptive term to describe a biomechanical lesion in the spine or related joints. Not unlike "dental caries" being a good descriptive term for cavities in teeth or "myopia" to describe nearsightedness. These terms were developed by their respective disciplines to describe the conditions they treat. To deny the existence of subluxations because you don't like or understand the term is ridiculous. Again, it is a term used by chiropractors to describe a specific perverse biomechanical process with a potential effect on the nervous system. Is the science there? Ask a patient suffering with severe sciatica after being adjusted for an L5 biomechanical derangement (subluxation) that provides sometimes instant relief if it is real? Or ask the headache sufferers who commonly receive permanent relief with chiropractic adjustments, if the phenomenon of a subluxation is legitimate.

The problem is not with the terminology; it is when the meaning behind the word is broadened beyond its intended scope. Practitioners who do this for their own gain are spurious opportunists, damage the profession, and should be dealt with firmly. Sadly, these people do exist and until we mature enough as a profession to fully standardize what we do through the unity of consensus, we will continue to be vulnerable to attack by our detractors.

Fair (adjective) "In accordance with the rules or standards; legitimate."
Keeping outliers in tow is an ominous process, I know because I sat on the College of Chiropractors of Ontario. I also know that there needs to be enough checks and balances to keep the process fair. I witnessed this fairness while sitting on the discipline committee."

What the authors of The Globe & Mail article failed to represent in their work is the exceptional level of competence with the administrative staff at CCO. These are the people who, on a day-to-day basis run the ship, and I assure you it is well managed. Complaints are processed expeditiously and with fairness, while always keeping the mandate of public protection front and center. The complaints committee is made up of chiropractors from the board, public members and members of the profession. This again is reasonable and fair. By the way, it is the same process for all of the other regulated health professions.

Bias (noun) "Prejudice in favour of or against one thing, person, or group compared with another, usually in a way considered to be unfair."
I am kind of an old fashion guy and to me, family is everything. For 41 years, my colleagues and this profession have been part of my extended family. As with my nuclear family, I take it personal when someone with part of a truth attacks my profession and my livelihood. I stand firm in my opinion that The Globe & Mail piece was motivated by bias. That angers me and made this article necessary. What saddens me is when members of my own profession collaborate in a process which damages our professional image with the public and thereby the livelihood of my fellow practitioners. Many chiropractors are having a tough enough time competing with the more "privileged players" in health care, without our own members circling the wagons and shooting in. There are avenues for addressing professional concerns within the boundaries of the profession and that is what is appropriate. Though, this is something best addressed face to face. I hope to get that opportunity.

Dr. Douglas Pooley graduated from the CMCC and has practiced in St. Thomas, Ont., for the past 40 years. He has represented the profession on national and provincial boards and has lectured nationally and internationally.


A reply to the Globe & Mail article: "Chiropractors at a crossroads: The fight for evidence-based treatment and a profession’s reputation"

Comments  

 
0 #11 Roger Berton 2019-03-04 15:07
That sad part is that you all have good points. I read the Globe and Mail articles and of the good and bad points which I currently recall interpreting, they don’t seem to be the same as the authors, not that that I hold any of that against Dr. Pooley :). But what this does tells me is our profession is so far right and left (almost like American politics) that don’t ever assume we will end up in happy middle ground prior to my retirement. We could also be having a pros versus cons debate at this point regarding the America State Board model versus our 20 times more expensive Canadian government self regulation Model....
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+7 #10 Joe Ghorayeb 2019-02-28 02:52
Excuse my brevity (word count).

There is no evidence to support the construct of “subluxation” - Chiropr Osteopat. 2009;17:13.

Chiropractic is a profession, not a modality (i.e. SMT). There is no evidence that SMT is effective in the management of visceral conditions:

1) Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD002119. DOI: 10.1002/14651858.CD002119.pub3.
2) Respiratory Medicine, Volume 103, Issue 12, 1791 – 1795.
3) JMPT , Volume 35 , Issue 3 , 235 – 243.
4)Chiropr Man Therap. 2018;26:10.
5) Can J Gastroenterol. 2011;25(1):39-40.
6) Int J Clin Pract, September 2009,63, 9, 1351–1353.
7) Journal of Clinical Chiropractic Pediatrics 2016 (Dec); 15 (3): 1280-1291.
8) JMPT 1991 Feb;14(2):110-5.

Placebo and ANS:
Philos Trans R Soc Lond B Biol Sci. 2011;366(1572):1808-17.

We can all do better.
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+8 #9 Joe Ghorayeb 2019-02-28 01:17
I was hopeful that this would be a balanced article when I read: “The middle, which by far represents the majority of practitioners, moderates both ends”. Unfortunately, Doug slid down a slippery slope, creating further divide between evidence-based chiropractors and those who prefer to enjoy the amenities of 2019, yet practice like it’s 1895.

I would encourage Doug and others who share his viewpoint to review this article (https://www.canadianchiropractor.ca/collaboration/msk-experts-5239) and consider the opportunities for growth and interprofession al collaboration, not to mention the enhanced image of the profession and the greater good to be offered to the general public as a result of profession-wide embracement of evidence based practice.
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-6 #8 Richard Hawthorne 2019-02-13 12:21
Then perhaps it is time for some of the research dollars go to studies that will support the use of chiropractic for the treatment of some visceral disorders. I have been in practice for over 27 years and the number of cases where people come in with a complaint of back pain and when corrected their (sometimes undisclosed complaint) of indigestion, constipation, dizzyness, or some other dysfunction, for which no medical test has been able to confirm a diagnosis, is suddenly gone. There are cases where there is an organic cause for these conditions, but there are cases where spinal/joint dysfunction causes nerve dysfunction resulting in autonomic dystonia. Google that diagnosis and read about the research that says chiropractic adjustments effect the autonomic nervous system, then try to tell me that chiropractic has no affect on health.
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-5 #7 Gord Burkholder 2019-02-12 13:07
Great opinion letter Dr. Pooley. Most health care disciplines have diversity of philosophy and practice within their membership. Diversity is healthy. It creates spirited debate, guides research and fosters innovation. Today, many medical practitioners use vitalistic approaches. The CCO has always upheld its duty to protect the public interest. Diversity and health care choice are in the public interest.
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-5 #6 Michelle Whitney 2019-02-10 13:19
Well said Doug. As a former elected member to the CCO who served on both Complaints and Advertising Committees, former Peer Assessor and founder of the So called vitalistic organization from Guelph, I found the G&M article to little more than a really bad piece of yellow journalism. Is it any wonder almost nobody reads the newspapers anymore? The insinuation that somehow the academics out of CMCC are somehow going to save the public from harm is amusing at best. There’s a place for academia as there is a place for the average Chiropractor to participate in the governance of its profession.
Chiropractic is a very diverse profession for which I am truly grateful. The CCO has always allowed for the free expression of the Science, Art and Philosophy of Chiropractic to be practiced in Ontario under the RHPA since the RHPA was enacted in 1991.
There is a organizing spirit that resides in all of us. To deny this is to deny our existence.
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+8 #5 Dawn Erskine 2019-02-08 13:38
The logical fallacies are strong in this piece. You cannot assert that chiropractic is evidence-based and yet use only anecdotes to defend it. Also, I do not believe that manipulation of any life force has any basis in any legitimate medical practice. On the other hand, the arguments did give me a chuckle.
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-14 #4 Rob Rosborough 2019-02-08 12:19
Sounds good to me Doug. I think Dr. Thyret who introduced us would be on board as well. Unfortunately I knew as soon as you use the word life energy some of the readers would lose interest and think you silly for thinking something like that. Dr. Pooley has served his patients and profession well for over 40 decades. Respect.
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-7 #3 Dr G 2019-02-08 11:40
Mr McPhail.

No doubt you "see the general public being harmed" because you look for it. Surely you understand observational bias.

Surely you also understand the scientific concept of "egocentrism" and "the curse of knowledge". You have a body of knowledge that your ego will not allow to be penetrated...ev en if there is compelling evidence to the contrary. Result...intell ectual dishonesty - and you are the only person in the room that believes that no one else sees it.

and..."If that is bias, we’re good with that." - thank you! Appreciate your candour.

I hope your hit pieces continue to drive more book sales.
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0 #2 Wayne MacPhail 2019-02-07 12:19
I'm one of the authors of the Globe and Mail stories. Our work revealed a serious problem within chiropractic, especially in Ontario. Vitalism within rank and file chiropractors and within the CCO has meant that patients are being scared, bilked and sometimes harmed by claims and treatments not based on good evidence. We’ve seen from the response to our stories from chiropractors, that those who wish to focus more on MSK conditions are embarrassed by unscientific claims, acknowledge serious issues with the leadership of the CCO and are afraid of deregulation or self-regulation.

Dr. Pooley's incorrect assertions about "life energy" and medicine are revealing and wrongheaded. And, we were very clear and precise about what we meant by subluxation. His "bad apples/outliers " argument is tired and dated.

Our motivation? We see the general public being harmed and want to bring these issues to the public’s attention. If that is bias, we’re good with that.
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