The practice of Chiropractic medicine continues to be a controversial treatment modality in spite of persisting efforts by the Association of Chiropractic Colleges (ACC) to “integrate” into general science based mainstream medicine. One of the main problems is that the foundational theory and basis for chiropractic rests upon tenuous non science based concepts.The “Chiropractic Paradigm” proclaims on the ACC web site that the theory of the "subluxation", a nebulous entity not demonstrated to exist (let alone be the originating cause of a plethora of human and animal diseases) as integral to the practice of modern chiropractic:
"Chiropractic is Concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.
A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.
A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence."
In spite of efforts by more evidence based chiropractic practitioners such as Samuel Homola DC who strive to limit the extensive scope of unfounded treatment claims, a significant proportion of chiropractors continue to implement pseudo scientific methodologies.
One of the dilemmas for this profession is that a large part of its work involves spinal manipulative therapy (SMT) a separate practice often erroneously assumed to be only chiropractic in scope. In fact, physiatrists, orthopedists, sports medicine practitioners, physical therapists, athletic trainers all employ SMT in their practices. There seems to be some evidence that SMT relieves back pain to an extent and can be traced back to ancient history. Though this technique has beneficial qualities it does involve some components of the placebo such as the laying on of hands and perceived variations to pain.
Chiropractic differentiates itself from traditional SMT by prescribing to specific implausible theories such as the subluxation and that this entity is the root of nerves impingement's that lead to disease. Though the present chiropractic society strives to dress this concept with scientific legitimacy, the bottom line is that such theories have not met the criteria of quality research. Therefore, chiropractors who are working to reform the practice and limit its scope are faced with having to completely shift the “chiropractic paradigm” in a big way- a daunting task:
"The dilemma reformers face is that chiropractors do not perform any service or deal with any condition not covered by some other health profession. State laws that enable them to practice either specifically mention the subluxation theory or describe it as the basis for chiropractic as an entity. Renouncing chiropractic's theoretical basis would eliminate its justification for existing as a separate profession.
Reformers acknowledge that they offer mainly the specialized skill of SMT. They believe that SMT is underutilized and that a substantial market exists for their skills. Although other health professionals can legally perform SMT or treat functional back disorders, most do not. To become skilled at SMT requires more time and effort than most physicians or physical therapists are willing to invest, especially when they feel that they may achieve the same clinical results over the long term with less demanding modalities."
Chiropractic medicine has origins specifically from the strange metaphysical pondering of one layman; Daniel Palmer who speculated that most disease was caused by spinal subluxations that impinged nerves thereby leading to disease:
“Obsessed with uncovering "the primary cause of disease," Palmer theorized that "95 percent of all disease" was caused by spinal "subluxations" (partial dislocations) and the rest by "luxated bones elsewhere in the body." Palmer speculated that subluxations impinged upon spinal nerves, impeding their function, and that this led to disease. He taught that medical diagnosis was unnecessary, that one need only correct the subluxations to liberate the body's own natural healing forces. He disdained physicians for treating only symptoms, alleging that, in contrast, his system corrected the cause of disease.
Palmer did not employ the term subluxation in its medical sense, but with a metaphysical, pantheistic meaning. He believed that the subluxations interfered with the body's expression, of the "Universal Intelligence" (God), which Palmer dubbed the "Innate Intelligence." (soul, spirit, or spark of life). [9] Palmer's notion of having discovered a way to manipulate metaphysical life force is sometimes referred to as his "biotheology."
Human chiropractic today, under the cover and dressage of “science” still has not gone past many of these implausible notions. It is therefore easy to imagine why other peculiar modalities such as odd and implausible diagnostics (applied kinesiology, contact reflex analysis, “nutritional” consultations, reflexology, and hair analysis among others) have taken root in chiropractic medicine.
The relationship to spiritual world views of the soul at least suggests that expanding these concepts beyond the human body were not immediately considered. Animal chiropractic and animal souls seem not to have been an initial part of the theory for this treatment modality. The leap to animals however, did take place using a similar “intuition” and integrative approach used in other alternative practices (Note the resemblance to the “natural correspondence” theory and “energy” pattern and flow concept of the "qi" found in TCM).
The transposing of chiropractic to animals seems to have little basis in research and relies on the general precepts of the slippery “subluxation” theory. In addition to being an unproven entity in humans it is interesting to note that “No part of chiropractic education deals with animals, and no part of veterinary education deals with manipulative forms of physiotherapy.”
However, a veterinarian or chiropractor can be “certified” to practice animal chiropractic after complying with about 150 hours of coursework. These educational courses are offered at five locations approved by the American Veterinary Chiropractic Association. A quick scan of two of the websites indicates that the concept of the “subluxation” is alive and well in the arena of animal chiropractic:
"Integrated Case management " -6.5 hours – (All of the following are addressed by lecture, in small group discussion and/or with expert panel debate through an open question forum.) Review of the chiropractic theories and the contemporary vertebral subluxation complex; define assess and apply animal chiropractic diagnosis of the vertebral subluxation complex; and, investigate the creation and application of appropriate clinical goals and applying them to our integrative treatment protocols.”-
"What is animal chiropractic? "
Animal Chiropractic understands the relationship of the spine and nervous system to proper function and over all well-being of small and large animals. The application of this art utilizes a small amplitude, high velocity thrust to areas of spinal subluxation in order to facilitate proper function of the nervous system resulting in enhanced performance and quality of life".
The jump from one mans “epiphany” for curing disease through spinal manipulations is difficult to comprehend. The leap to animal chiropractic becomes even harder to grasp, especially if you consider the enormous variation in body types and sizes found in the animal kingdom.
Though animal based chiropractic education seems to address some anatomical topography, there continues to be a theoretical gap in the transition from human focused approaches to animal techniques. Additionally, the obvious fact that human body architecture is based on a bipedal mechanics and the vast majority of other animals are quadrupeds needs serious attention when considering practical and functional chiropractic transitions from human treatment theory to the rest of the animal kingdom.
Chiropractic medicine seems to continue to base its efficacy more on a priori knowledge, belief, testimonials, and pseudo scientific modalities rather than on scientific plausiblity and quality evidence based research. It is prudent to review some of the basic strategies the American Veterinary Medical Association has developed for veterinarians that are considering alternative modalities:
| "AVMA Guidelines for Complementary and Alternative Veterinary Medicine |
| (Approved by AVMA House of Delegates 2001; revised by the AVMA Executive Board April 2006) |
Introduction These guidelines are intended to help veterinarians make informed and judicious decisions regarding medical approaches known by several terms including "complementary," "alternative," and "integrative." Collectively, these approaches have been described as Complementary and Alternative Veterinary Medicine (CAVM). The AVMA recognizes the interest in and use of these modalities and is open to their consideration. The AVMA believes that all veterinary medicine, including CAVM, should be held to the same standards. Claims for safety and effectiveness ultimately should be proven by the scientific method. Circumstances commonly require that veterinarians extrapolate information when formulating a course of therapy. Veterinarians should exercise caution in such circumstances. Practices and philosophies that are ineffective or unsafe should be discarded." |
This is is a call to veterinarians (and in essence, to all health providers) that we have a responsibility to provide effective and sound options to a public that entrusts us to find and offer them. Human and animal chiropractic medicine for the most part, has not met those standards.
Ref:
www.chirobase.org/01General/controversy.html
www.chirobase.org/05RB/BCC?update.html (dated, though good assessmant )
Animal therapy over the ages2. chiropractic 3. homeopathy. Haas BK. Veterinary heritage. 1999 Nov; 22(2):38-42
No comments:
Post a Comment