Once again, I spent my five minutes on Facebook and found a ripe topic to share with you. There is a trend in the subluxation denier movement, to dismiss the chiropractic vertebral subluxation because chiropractors don’t use the standard medical definition of the term “subluxation.” This approach is wrong on several levels most notably that it is ahistorical and lacks adequate evidence. For those of us who aspire to being evidence-informed, this is important to discuss.
The First Call to Dismiss Subluxation because of Medical Definition
Let’s start with the literature. The first time this approach was attempted in the chiropractic literature was 1984 and 1985. That’s right – the tactic is not new. If you care about evidence, you should know your own literature.
If you study Part 9 of my new set of papers on The Chiropractic Vertebral Subluxation, you will read the section called Review of Critical Literature. In that section, I point out that Brantingham proposed that the profession get rid of the term “subluxation,” because the ways in which the profession uses the term did not meet the medical definition. Without demonstrating any real perspective on the chiropractic literature up until that point, by 1988, Brantingham proposed we adopt the osteopathic term, “somatic dysfunction,” and get rid of the term subluxation.
Brantingham’s proposal was refuted by subluxation theorists from that time, namely Lantz and Keating. Lantz called him out in terms of his lack of references. Keating suggested a better approach would be to develop an operational definition of vertebral subluxation.
The Chiropractic Vertebral Subluxation Stands Alone
While the profession still confronts the issues that Keating brought up, effective operational definitions are needed, we also face the same types of unsubstantiated dismissivism as Lantz critiqued.
If you read Part 10 of the papers, you will see Keating’s proposals in more detail, including his call for systematic and well-planned case studies throughout the profession. You will also learn about Boone and Dobson’s idea that we need to start with a functional definition of vertebral subluxation. That will lead to testable and multiple operational definitions. You will also learn about Kent’s proposal that multiple techniques within chiropractic should lead to different operational definitions.
This all leads to the real issue, that the chiropractic profession, which is one of the largest health professions in the world, has developed its own lexicon over the course of 125 years (give or take a few years).
To dismiss the chiropractic vertebral subluxation because you are stuck on the medical definition of the term “subluxation” is an approach lacking in evidence. An evidence-based approach to this question must include reference to the profession’s development of the term. That development is mapped out in the 10 papers, which included a history of theory and research along with the internal debates. Read it. And, don’t confuse the word subluxation with the term “chiropractic vertebral subluxation.”
Brantingham, J. A review of some current and past literature regarding basic chiropractic hypotheses. Dyn Chiropr, 2 (8) (1984), p. 6
Brantingham, J. A survey of literature regarding the behavior, pathology, etiology, and nomeclature of the chiropractic lesion. ACA J Chiropr, 19 (8) (1985), pp. 65-70
Brantingham, J. A critical look at the subluxation hypothesis. J Manipulative Physiol Ther, 11 (2) (1988), pp. 130-132′
Lantz, C. A critical look at the subluxation hypothesis: to the editor. J Manipulative Physiol Ther, 13 (1) (1990), p. 42
Keating, J. A critical look at the subluxation hypothesis: to the editor. J Manipulative Physiol Ther, 13 (6) (1990), pp. 350-351
Brantingham, J. In reply. J Manipulative Physiol Ther, 12 (2) (1989), p. 154
Senzon, S. Chiropractic Vertebral Subluxation Part 10: Integrative and Critical Literature: 1996-1997. J Chiro Hum. 25(Dec) (2018), pp. 146-168.
Senzon, S. Chiropractic Vertebral Subluxation Part 9: Complexes, Models, and Consensus: 1979-1995. J Chiro Hum. 2018, 25(Dec);, pp. 130-145.
Faulkner, Foley, and Senzon. Palmer Chiropractic Green Books: The Definitive Guide. The Institute Chiropractic. 2018.
Rome, P. Medical evidence recognizing the vertebral subluxation complex. CJA. 2016; 44.
Rome, P. Terminology relating to the vertebral subluxation complex and the manipulative sciences. Part 1. CJA 2017;45:73-89.
Rome, P. Terminology relating to the vertebral subluxation complex and the manipulative sciences. Part 2. CJA 2017;45:90-129.
Kent, C. Models of Vertebral Subluxation: A Review. AVSR. 1
Boone and Dobson. Vertebral Subluxation Model. AVSR. 1-3
The Impact of Flawed Papers
First, I was asked, why such a fuss over a 15-year-old opinion paper? Peer-review is considered a scientific process. (Caveat – there is a wide range of quality in terms of journals, papers, editors, and authors.) After going through peer-review however, any paper is considered scientifically validated. This takes it above mere opinion and places it in the annals of the profession’s literature. The more it is cited, the more it reaches higher levels of eminence. The age or origins of a paper are irrelevant to those factors.
The problem comes when a paper has incorrect facts to support its arguments. This problem is magnified when there are multiple authors who are well published and well respected. Then, an assumption is often made by the reader and the opinions or mistakes, stated as facts, become facts in future papers.
Impediments to Chiropractic Definitions
The article bases its rationale for creating a new definition for the profession on three “impediments to the creation of a credible definition of chiropractic.” These are:
– Departures from accepted standards of professional ethics
– Reliance on obsolete principles of chiropractic philosophy
– Promotion of chiropractors as primary care providers
I agree with the third one. When I was trained at Sherman in the 90s, we were taught to be portal of entry doctors. This remains a reasonable view of the profession. So, let’s look at the other two.
Professional Ethics and Pattern Analysis
Let’s begin with one of their first critiques about practicing chiropractors and their ethics. The authors complain that practice management companies that advise practitioners not to adjust on the first visit are basing this on unethical practices and a lack of clinical rationale. The fact of the matter is, this practice originated from empirical research beginning in the 1930s and relates directly to the clinical rationale referred to as chiropractic pattern analysis. Whether practice management programs are teaching this or not could certainly be investigated.
One of the core elements of pattern analysis is to determine whether there is a neurological component being assessed related to the vertebral subluxation. The clinical rationale is that if the patient is in the exact same physiological pattern, as assessed by objective measures, on consecutive visits, then indications of a vertebral subluxation impacting the neurophysiology may be present.
This is an issue of adequate literature review. The authors do not cite the origins of the practice and we must assume they are either unaware or dismissive. Nevertheless, this is a failure of proper referencing and peer-reviewers not calling out the authors on the error.
The Ethics of X-ray Analysis for Vertebral Subluxation Assessment
Another ethical complaint of the authors relates to the routine x-ray analysis to detect the location of vertebral subluxation. They include only one reference for this practice and fail to capture the ubiquity of this clinical paradigm within the chiropractic profession. After all, the practice dates to the earliest days of chiropractic and led to some of the most detailed explanations of vertebral subluxation assessment ever developed.
For example, in Part 8 of the new series on The Chiropractic Vertebral Subluxation, I describe the definition developed by the American College of Chiropractic Roentgenologists in 1966. The first x-ray diplomates in the profession included some of the leading scientists, researchers, and clinicians from chiropractic’s first century. They concluded, based on x-ray and cine studies, that vertebral subluxation should include five types. (See the table from the paper linked below and also the book The Complete Chiropractor.) Their definition impacted the profession for decades.
Recent critiques in the profession about x-ray analysis should demonstrate a more complete knowledge of the history of this practice. This is another failure of peer-review and literature review.
Infidelity and Beliefs of the Chiropractic Majority
The most outrageous claim of the authors relates to the term “fidelity.” They imply that many chiropractors “promote unscientifically unreasonable beliefs,” which originate with D.D. Palmer and extends to the terms “subluxation” and “Innate Intelligence.” They conclude it is unethical for chiropractors to convey “historical chiropractic beliefs” and allow them to be expressed as “clinical truths.”
Nowhere in the article do the authors provide a comprehensive literature review on the historical or current state of research, knowledge, or theoretical understanding relating to vertebral subluxation. Instead, they describe several erroneous claims about D.D. Palmer’s approach to developing his models (see last post) and their personal opinions.
Also, as noted in the last post, they do not describe an adequately referenced understanding of Innate Intelligence. For example, they use terms like impractical, implausible, and indefensible. They dismiss Innate Intelligence as merely vitalism or metaphysical (which are limited views on the topic).
So, they dismiss as unethical several core approaches to chiropractic practice, approaches that have been embraced and utilized by the profession for decades, without adequate references.
Further, they cite the McDonald study, which demonstrated that 88 percent of the profession use the term subluxation. Then they state that this majority of the profession could only embrace these postulates through “a suspension of disbelief,” and anti-scientific thinking.
Does anyone else find this troubling? Is it possible that a small handful of academics have the corner on what is “true” and “real” and “scientific,” and most of the profession are antiscientific, delusional, and live in a state of “suspended belief?” Does that seem like an ethical approach or a misguided one?
A Straw Man
I will follow up with more about this paper soon. In the meantime, let’s acknowledge that two of their three points are mistaken or at least distorted. They are based on incorrect facts, inadequate references, unsupported assumptions, and a wild accusation that most of the profession is not using reason and logic. Then, they want to solve the problem that they say exists.
Perhaps it would have been better to just state their view and opinion about the future of the profession without trying to establish a foundation for their reasoning.
One of the real problems with the chiropractic peer-reviewed literature is that a handful of flawed articles have had a very large impact. This problem is exacerbated because there are not enough scholars or scientists taking the time to debunk and critique the flawed papers.
The Chiropractic as Spine Care Paper
One great example of this popped up in my latest scan through the Facebook pages. I came across an interesting fact; some chiropractic international organizations and teaching programs base their rationale on one of these flawed papers. The paper was published in 2005 in Chiropractic & Osteopathy, a journal known for publishing articles with historical errors, circular reasoning, and self-referential citation patterns.(1) The article is, Chiropractic as spine care: a model for the profession by Nelson et al.(2)
I will write more about this paper in the future. In the meantime, let’s just acknowledge for a moment, it is cited 127 times in google scholar and 57 times in PubMed Central.(3) Also, it was listed as a rationale for the new Keiser chiropractic college and is cited by leaders of the WFC. One paper, big impact.(4)
I will write more about this paper in the future. In the meantime, let’s just acknowledge for a moment, it is cited 127 times in google scholar and 57 times in PubMed Central.(3) Also, it was listed as a rationale for the new Keiser chiropractic college and is cited by leaders of the WFC. One paper, big impact.(4)
No Critiques Means the Literature is Failing Us
Unfortunately, the critiques of the article are few and far between. There are no letters to the editor complaining about its flaws and no published opinion papers tearing apart its arguments.
What does that tell us? Is it beyond critique? Or do other papers in the literature just assume it is correct because it made it through peer-review? Or that it has so many credentialed authors that it must be right? Or, is it possible that there are not enough experts knowledgeable about the main suppositions in the paper to properly evaluate it? These are the questions we must address.
Beginning a Critical Review
In Part 2 of the recent series on Chiropractic Vertebral Subluxation, I included a section critically reviewing the literature. In that section I was able to point out one of the problems with the Nelson et al paper. I will describe it and add another below. However, there are more than two.
The problems I focused on were related to their proposed “Palmer Postulates.” The “postulates” they developed were based on some mistaken facts and inaccurate assumptions about D.D. Palmer and his theories. Whether the postulates accurately depict Palmer’s chiropractic paradigm should be explored separately.
The point I want to share today is that the evidence they use to support the development of their postulates is flawed. This affects more than just the fact that the authors derived their postulates from faulty data, but it also weakens the whole paper substantially. After all, they find the postulates invalid and then propose their own model for the profession.
When viewed from the evidence, or the primary sources, their whole argument falls apart. It is flawed.
D.D. Palmer Conducted a Systematic Investigation of the Cause of Disease
In Part 2, I point out that Nelson et al’s assessment about how D.D. Palmer developed his initial theories was incorrect.(5) My main reference for this were his own words, direct quotes. For example, Nelson et al write, “there is no evidence that Palmer undertook any sort of systematic exploration of the spine/health relationship,” following the first chiropractic adjustment.
The fact is, he did. He even said, after the Lillard adjustment, “I then began a systematic investigation for the cause of all diseases and have been amply rewarded.” Other primary sources demonstrate that he did as well. So, one proof of their argument was incorrect.
Nelson et al, also suggest that D.D. Palmer’s “method of discovery was by inspiration and revelation.” That is just not accurate. An analysis of D.D. Palmer’s writings from 1892 to 1910 demonstrates otherwise. Sure, he had sources of inspiration, and I write about the strangest elements of that in the article and more so in The Definitive Guide.(6) But his main approach was empirical and guided by book studies.
Innate Intelligence is Better Described as the Law of Organization than Vitalism
Even though the philosophy of chiropractic was described in terms of Vitalism, mainly starting in the 1990s with Dean Black, Ian Coulter, David Koch, Sid Williams, Ralph Boone, and Graham Dobson, it is not necessarily the most adequate way to describe D.D. Palmer’s theory of Innate Intelligence. Dismissing the theory of Innate Intelligence as merely Vitalism ignores the complexity of chiropractic theory as it was developed and described between 1902 and 1999.(7)
After all, much of the theory is better described in terms of self-organizing systems, which are now a common viewpoint about how organisms are defined as alive.
My first approach to an evidence-based history of chiropractic was to count every usage of the term “organization” found in the Palmer Chiropractic Green Books. I analyzed each definition and found at least 88 uses that were distinct. Innate Intelligence was defined in the same ways the early theoretical biologists were using the term; as a unique type of organization of the parts comprising the dynamic and adaptive whole. After all, Stephenson defined it as “the law of organization.” Thus, I demonstrated that chiropractic theory developed alongside biological theory in the twentieth century. I published those findings twenty years ago.(8)
So, when I read a paper like this classifying Innate Intelligence as just vitalism, implausible, metaphysical, and indefensible from a scientific perspective, I am awestruck at the lack of understanding about the term. After all, the literature is there for all to study. Why not get it right? Or at least complete?
D.D. Palmer’s first use of the term Innate Intelligence was in relation to the development of bony osteophytes.(9) His later uses of the term included a non-materialist viewpoint. The complexity of D.D. Palmer’s ideas are not included in the proposed “postulates,” leaving yet another hole in Nelson et al’s argument.
If the Postulates are Based on Faulty Facts and Reasoning, What Else is Wrong?
I will plan to dissect this paper in more detail in coming months. But just from this preliminary view, we are forced to question some of the basic assumptions. If the postulates are not based on good sound reason and evidence, what else is wrong with the paper? Just because a paper has yet to be critiqued in the literature does not mean it is correct. The organizations that base their rationale on this paper should study it more carefully.
This paper and more like it are dissected in the new course at TIC: The CVS Lectures
- Examples: The New Chiropractic; The Five Eras of Chiropractic; Chiropractic Background
- Chiropractic as spine care: a model for the profession
- PubMed; Google Scholar
- WFC President; Keiser University Dean
- The Chiropractic Vertebral Subluxation Part 2: The Earliest Subluxation Theories From 1902 to 1907; Palmer Chiropractic Green Books: The Definitive Guide
- You may read the section here: Assumptions in the Literature
- Coulter’s Institutional Philosophy of Chiropractic; Koch’s Has Vitalism Been a Help?; Boone and Dobson’s Proposed VSM Part 2; What is Life?
- Causation Related to Self-Organization and Health Related Quality of Life Expression based on the Vertebral Subluxation Model, The Philosophy of Chiropractic, and the New Biology
- Innate Intelligence Part 2 (1903)
All I have to do these days is peek at a Facebook discussion group at 1am on a Friday morning, and, boom, I have enough content to write another blog post. The latest blistering critiques I observed involved one chiropractor poking fun at chiropractors’ use of the term “salutogenesis,” as if it was a new fad. This was responded to by comments referring to a “fringe” group in chiropractic and feigned ridicule that the term salutogenesis emerged from medical research, so there must be some paradox here.
This barely took me five minutes to read and the amount of error, illogical thinking, and shear confusion about the chiropractic paradigm was astounding. Forget about the obvious lack of any historical perspective.
Chiropractic and Medical Research
Let’s start with some perspective. The chiropractic paradigm and vertebral subluxation theory has integrated the best of medical research since the earliest days of the profession. Good science is good science. If research is undertaken that bolsters, supports, or leads to new valid hypotheses, chiropractors have always been at the forefront of integrating it. Here are a few examples.
It is well documented that D.D. Palmer was “into the literature.” In his 1910 book, Palmer demonstrated a mastery of medical textbooks on the topics of anatomy, physiology, and surgery. Historians were able to document the fact that he cited a wider range of textbooks than the average medical student of the time was required to read. He was even able to cite some earlier editions going back 200 years. His theory of neuroskeleton was a contribution to the literature on neurectasia and nerve-stretching.
In 1911, B.J. Palmer integrated the full text of a JAMA article on spinal cord tension. He included the entire article with 12 case studies of spinal cord surgery in order to expand his model of vertebral subluxation. This was so that he could account for the neurological distortions at the ends of the spine. He and his students expanded on and researched the cord pressure model well into the 1940s.
One instance of early chiropractic history is very interesting on this topic. O.G. Smith, who was D.D. Palmer’s 10th student, did extensive dissections of the IVF and intervertebral discs. He even took photos of microscopic ligamentous adhesions. Smith’s student, Harold Swanberg, wrote the first textbook on the human IVF. It was the standard work in medical schools for decades.
Other examples include the integration of Speransky’s textbook, Basis for the Theory of Medicine, throughout the profession in the 1940s, 50s, and 60s. Also, the chiropractors were amongst the first to integrate Selye’s research into subluxation theory. In fact, I concluded in a recently published research paper that it is impossible to discuss post 1950s vertebral subluxation theory without including Seyle. Homewood captured this well when he wrote,
“Selye may be said to have investigated the ‘physiology’ of stress, whereas the chiropractic profession has concerned itself with the ‘anatomy’ of stress.”
Homewood is a great example of how the integration of medical research into subluxation theory wasn’t just conducted at the “straight schools.” After all, he graduated under Budden at Western States (Budden bought Western after he left his position as dean of National), and became president of CMCC.
Another great example is the integration of Breig’s spinal cord surgery paradigm of adverse mechanical cord tension into vertebral subluxation theory. Breig’s research was integrated into the profession as early as the 1960s by Faye and in 1970s, 80s, and 90s, by several others including Joe Janse, Lowell Ward, J.D. Grostic, Donald Epstein, and William Ruch.
Is it any wonder that chiropractors are integrating salutogenisis into their models and research? I think not.
Even though Dr. Kent was writing about the term in 2002, the first time I heard it in conversation was at a lunch at John F. Kennedy University about ten years ago. My colleague and good friend, Joel Kreisberg (trained chiropractor and gifted homeopath), brought up the term when I was discussing the concept of Innate Intelligence to our mutual grad students. He said that he chose to use “salutogenesis” rather than the traditional chiropractic terminology.
I studied the term soon after and read all of the works of Antonovsky, as well as some of the more current research on the sense of coherence scale. This perspectives was included in some of the recent CVS papers.
The next time I heard the term in a public forum was an excellent presentation at IRAPS by Dr. Donofrio, Vice President for Academic Affairs at Sherman College of Chiropractic. Dr. Donofrio explained how the language and models of salutogenesis were congruent with theories put forth by Ralph Stephenson in 1927 and D.D. Palmer before him. Stephenson’s model of the momentum of health was Donofrio’s example. It was a great comparison.
Interestingly, Antonovsky used the term “dis-ease” with a hyphen in the 1970s to distinguish the philosophical approach towards the genesis of health and away from medical disease perspectives. As you may know, D.D. Palmer first coined the term “dis-ease” in an 1887 ad, when he was still a Magnetic Healer. It was at the core of his chiropractic paradigm and distinguished the overall outlook of chiropractic in respect to the pathogenic perspective of biomedicine.
The similarities to their outlooks on the creation of health are very similar. Antonovsky wrote,
“The important question, the fundamental question in scientific, humanitarian, and philosophical terms, became: How do some of these people manage to stay reasonably healthy? I was beginning to be freed from the pathogenic orientation.”
In a similar perspective, almost 80 years earlier, D.D. Palmer wrote,
“One question was always uppermost in my mind in my search for the cause of disease. I desired to know why one person was ailing and his associate, eating at the same table, working in the same shop, at the same bench, was not. WHY? What difference was there in the two persons that caused one to have pneumonia, catarrh, typhoid, or rheumatism, while his partner, similarly situated, escaped? WHY?”
It is time we stop the doublespeak in the chiropractic profession. There is enough nonsense in the media these days in terms of “fake news” and the “post-truth” world. It is shear propaganda to keep shouting the same incorrect facts and expect it to catch on as a Meme or even worse, as a belief system.
It is well documented that a very small group of academic chiropractors have been stoking the fires of the chiropractic discourse, saying the same things over and over again, for years. Unfortunately, some of these things are incorrect and published in the peer reviewed literature. You know what I mean, the subluxation is not researched, philosophy is only a legal ruse, there is some divide between vitalistic and holistic thinking that cannot reconcile with science or evidence. The list goes on.
As you know, none of that is true.
The biggest lie in all of this is this idea of “the fringe” or “the minority” in the chiropractic profession. There is some research on how chiropractors think and practice. Most of it is methodologically flawed for various reasons or at the least, limited.
Interestingly, one paper noted a comparison between the views about subluxation between “All DCs” (based on a study) and a group of academic researchers surveyed at a conference. Ninety percent of “All DCs” felt chiropractic should keep the term “vertebral subluxation complex.” Only thirty-one percent of participants at the conference felt this way. Thus, we refer to the 70% of academic researchers at such conferences as, the fringe, the minority, and out of touch.
The Chiropractic Paradigm
The chiropractic paradigm, which emphasizes the correction of vertebral subluxation so that the neurologically mediated expression of health, from the body’s inherent source of intelligence, may be more fully expressed, is well supported in the medical literature. Scientific research is vital for us to establish this paradigm more fully in the literature. Salutogenesis and its Sense of Coherence Scale are important ways to move that agenda forward.
A Few References
Antonovsky A. Health, stress, and coping. San Francisco. 1979.
Antonovsky A. Unraveling the Mystery of Health-How People Manage Stress. 1987.
Antonovsky A. The structure and properties of the sense of coherence scale. Social science & medicine. 1993;36(6):725-733.
Donofrio J. Incorporating salutogenesis in a new chiropractic paradigm. Paper presented at: 9th Annual International Research and Philosophy Symposium2012; Sherman College of Chiropractic, Spartanburg.
Gaucher-Perslherbe, P., Chiropractic, an illegitimate child of science? II. De opprobira medicorum. European Journal of Chiropractic, 1986. 34(1986): p. 99-106.
Gaucher-Peslherbe P. Chiropractic: Early concepts in their historical setting. Chicago: National College of Chiropractic.; 1993.
Gaucher-Pelherbe, P., G. Wiese, and J. Donahue. Daniel David Palmer’s Medical Library: The Founder was “Into the Literature.” Chiropr Hist, 1995. 15(2): p. 63-69.
Kent, C. Salutogenesis. 2002.
Kent, C. Giving Birth to Health. Dyn Chiro 2011. 29(7).
Lindström B, Eriksson M. Salutogenesis. Journal of Epidemiology and community health. 2005;59(6):440-442.
McCoy, M., Kent, C. Vertebral Subluxation Research: An Agenda to Explore the Epidemiology of Vertebral Subluxation and the Clinical Outcomes Related to Management. A. Vert Sub. Res. Aug 5, 2013:29-32.
Rome, P. Terminology Relating to the Vertebral Subluxation Complex and the Manipulative Sciences. Part 2. Chiropr J Australia 2017;45:90-130.
Senzon, S. The Chiropractic Vertebral Subluxation Part 3: Complexity and Identity From 1908 to 1915. J Chiropr Humanit 2018;25C:36-51.
Senzon, S. The Chiropractic Vertebral Subluxation Part 5: The First Research Era From 1928 to 1949. J Chiropr Humanit 2018;25C:67-85.
Senzon, S. The Chiropractic Vertebral Subluxation Part 7: Technics and Models From 1962 to 1980. J Chiropr Humanit 2018;25C:99-113.
Smith D. Functional salutogenic mechanisms of the brain. Perspectives in biology and medicine. 2002;45(3):319-328.
Triano, J., Goertz, C., Weeks, J., et al. Chiropractic in North America: Toward a Strategic Plan for Professional Renewal-Outcomes from the 2006 Chiropractic Strategic Planning Conference..J Manipulative Physiol Ther 2010;33:395-405.
A Chiropractic History Lesson
From Simon Senzon
In the last few days I was confronted with some of the latest claims from the chiropractic peanut gallery. I am sure you know what I am talking about.
Two of the claims were from a video posted on Facebook of a chiropractor lecturing to a classroom of chiropractic students. This individual said many things that were biased and incorrect. Two of them stand out for me:
- He stated that early chiropractic and osteopathy were the same. (That is incorrect.)
- He also equated subluxation with a belief in God. (This is just absurd.)
Some of the confusion around these questions comes from decades of chiropractic authorities stating their opinions as facts and teaching that to students. Now those students are teaching their versions, without any evidence, to the latest generation. This practice must stop.
Let’s start with the first comment. The fact of the matter is, in the early days of the profession, the chiropractors and the osteopaths were at war for several years. Each accused the other of stealing theories and practices. A few important facts to note:
- D.D. Palmer was well-read in the osteopathic literature and thus was able to articulate precise differences between his theories and practices versus osteopathic approaches.
- Several of the early chiropractors were trained as osteopaths and found the two sciences distinct.
- The defense in the Morikubo trial, which was the landmark case distinguishing the two professions, successfully argued against the prosecution’s osteopathic expert witnesses. The defense demonstrated that chiropractic’s science included a unique view of the nervous system, technique included nerve tracing and a quick thrust to release nerve impingement at the IVF, neither of which was taught by osteopaths, and the philosophy of chiropractic was based on the concepts of Innate and Educated, also not taught in osteopathic schools.
As to the strange notion that vertebral subluxations has something to do with God, that is just ignorance incarnate. Anyone who states something like this demonstrates a lack of evidence about the ubiquity of vertebral subluxation theory across the entire chiropractic profession (every school) for over 100 years. Subluxation has always been viewed as the cornerstone of the profession despite the claims of a vocal minority.
On this point, I’ll refer you to two of the new papers. You should read the Introduction (Part 1), which has a section on Philosophy and Subluxation. Also read Part 8, especially the section on the distinctions made decades ago by the objective “straight” movement. From that point on, subluxation theory should be classified in terms of structure, neurology, and endogenous organization.
In terms of the early philosophical models of Innate Intelligence, psychospiritual health and wellbeing may still be studied in relation to the correction of vertebral subluxation.
Some other claims that popped up on my Facebook feed this week include at least one attempt to conflate all vitalistic perspectives with magical thinking and another attempt to conflate all subluxation-based practitioners with B.J. Palmer’s sacred trust.
Again, claims without sufficient evidence are just opinions. I have written in the past about at least five ways of thinking that might be attributed to chiropractors. I even published a chart conveying this evidence-based approach to perspectives on vitalism. Oversimplifying this issue is never going to move the profession forward. Only by embracing the complexity of these ideas might we begin to have real dialogue.
This also goes for the claims about the sacred trust and how it relates to today’s practitioners.
Finally, one other comment focused on the emphasis of the last few decades by many chiropractic researchers. Here are some additional facts:
- Starting in the 1970s and 1980s the research focus of much of the chiropractic profession turned away from somatic relationships between vertebral subluxation and neurodystrophic and neuropathic processes.
- The research in the profession up until that point was mainly focused on those areas.
- The shift in focus had more to do with politics, insurance reimbursement, and garnering research funding than the objective pursuit of science. (Science is always shaped by social and cultural forces.)
- The profession may still examine the myriad hypotheses about vertebral subluxation that have yet to be studied with modern research designs.
Some of these issues and facts were covered in my recent series of papers. Below are links to a few that are relevant. If we don’t confront the peanut gallery with evidence, the small group of academics that keep shouting opinions may impact the future of the profession.
The Chiropractic Vertebral Subluxation Part 1: Introduction – https://www.sciencedirect.com/…/artic…/pii/S155634991830010X
The Chiropractic Vertebral Subluxation Part 7: Technics and Models From 1962 to 1980 –
The Chiropractic Vertebral Subluxation Part 8: Terminology, Definitions, and Historicity From 1966 to 1980 – https://www.sciencedirect.com/…/arti…/pii/S1556349918300160
April was an outstanding month at The Institute Chiropractic. The new course, The CVS Lectures, was launched, ten new papers on The Chiropractic Vertebral Subluxation from 1897 to 1997 were published, and a fantastic book review on Palmer Chiropractic Green Books: The Definitive Guide was posted. We have so much more to come.
The CVS Lectures
The first week of The CVS Lectures is now live. All TIC Members have instant access to this 16-week course on The Chiropractic Vertebral Subluxation (CVS). The central lectures of the course involve the arguments from the ten papers discussed below.
The first week includes an introduction to the concept of mistakes in the historical literature and how they may affect practice.
Part two is a nine-minute lecture on the “Bohemian Stuff.” That talk is a precursor to several lectures on the Morikubo trial and its impact on chiropractic practice. The complete schedule of The CVS Lectures will posted soon.
- Each week is 20-30 minutes of lectures.
- Discussion forum is ongoing.
- Join the course at any time.
- 4 recorded Q & A sessions.
- The 16-week course is $500.
- Course registration includes yearly TIC Membership:
The other 8 sets of lectures include: Critiquing the Subluxation Literature, An Historical Perspective on Evidence in Chiropractic Research, The Impact of Historical Errors on Chiropractic Practice, Philosophy, Innate, & Dissonance, Perspectives on the Chiropractic Vertebral Subluxation, Chiropractic Research in the 1940s-1960s, The Importance of Consensus in Chiropractic, and A History of Subluxation Denialism.
Ten Papers on The Chiropractic Vertebral Subluxation
The yearly issue of Journal of Chiropractic Humanities was published four months late. Volume 25 was published. The volume includes 168 pages of text. Simon Senzon’s new series begins on page 10 and completes on page 168. The journal is open source. More blog posts will explore the themes in coming months. The new course will involve discussions of all ten papers. Here are the links to read them online or download the pdfs:
The Book Review
Steve Agocs, chiropractic history professor at Cleveland University, just posted an excellent review of the new book Palmer Chiropractic Green Books: The Definitive Guide. Dr. Agocs posted the review to facebook and wrote,
“To summarize: every chiropractor needs to own and read a copy, the amount of work that went into this is STAGGERING, and after 20 years of studying chiro history and 12 of teaching it, I found a lot of stuff I didn’t know and pictures (there are over 600! In color!) I’d never seen. It’s a work of heartbreakingly staggering genius.”
Steve does a great job of capturing the significance of this book. He also acknowledged the excellence involved in categorizing 123 distinct Green Books. And, as an historian he truly appreciated the work that it took to explore the context of each book.
On his 61st birthday, on March 6, 1906, D.D. Palmer gifted Shegetaro Morikubo with chiropractic. He presented Morikubo with a bound edition of The Chiropractor’s first year of issues. As noted in our book, Palmer Chiropractic Green Books: The Definitive Guide, this included the only KNOWN inscribed book from the founder of chiropractic. But what D.D. truly gifted to Mori was the philosophy and practice of chiropractic.
*In 1910, D.D. Palmer wrote that March 7, was his birthday.
Morikubo was one of D.D. Palmer’s last students who was taught at Davenport while he was head of the Palmer School of Chiropractic. This type of rare distinction was shared with a few of the early luminaries. For example:
D.D. Palmer’s Students
O.G. Smith was one of the first ten students. According to Faulkner’s excellent book, Smith was with D.D. for about six years in Davenport, Santa Barbara, and Chicago. A.P. Davis was one of the first students but he also spent time with D.D. years later in Portland, Oregon. C.S. Cooley was one of the only students enrolled under D.D. during his three months of teaching at the Palmer-Gregory School in Oklahoma. T.F. Ratledge, who also spent time with D.D. in Oklahoma went on to provide D.D. with his final teaching job at his Ratledge School in California. J.R. Drain attended D.D. Palmer’s final lecture tour through Davenport in 1913, just before he died. And then there was B.J. Palmer, who carried on his father’s paradigm well into the twentieth century, without whom the profession would not have fully emerged.
Unlike those other early pioneers who led schools and political organizations, Morikubo was unique.
Soon after Morikubo received a life-changing chiropractic adjustment from D.D. Palmer, signed up as his student, and was presented with this text, D.D. Palmer was jailed for advertising to “cure” in The Chiropractor. The day after D.D. was sent to jail on March 29, 1906, Morikubo published a rebuke to the people of Iowa and America. He criticized a country that stood for ideals of liberty and freedom yet jailed an innocent healer for proclaiming his results.
One of D.D. Palmer’s friends, Samuel Weed, wrote to D.D. in jail,
“I saw later, Doctor, an article written by Shegetaro Morikubo, a student of Chiropractic under you from far off Japan. He was present at your trial and was surprised and disgusted that such injustice could be done under the stars and stripes.”
“His sensible words make me ashamed, while I honor him for his masterful rebuke of the wrong done to you; his words should make the people of Iowa so much ashamed that they would wipe out the evil law, or remedy the malicious interpretation of it that has imprisoned “for publicly professing to cure and heal without a license” one of her citizens who has discovered and teaches a science and art that leads the van of all that profess to cure and heal by adjusting the cause of disease, instead of curing and healing the disease themselves.”
After leaving jail, D.D. Palmer moved to Oklahoma. Morikubo continued to study with B.J. Palmer until his graduation on December 22, 1906. Soon after graduation, he moved to LaCrosse, Wisconsin, which was the legal hot spot in the battle to legalize chiropractic. Morikubo moved there to force the issue.
Morikubo opened his office in the Macmillan building, which was where A.U. Jorris, DO, practiced. This was a direct challenge to the state board. Jorris was on the board and was renown in osteopathic circles for his successful legal case against two psuedo-chiropractors in 1905 and 1906.
Morikubo defied the board by growing his practice. In March or April of 1907, Morikubo writes, “If the Wisconsin board of Osteopaths claim that chiropractic is a part of Osteopathy they would commit robbery… If my statements, of equal rights, can be construed to “denied the state board” then defy the “state board,” I will until they “arrest him” and prove that I am practicing Osteopathy.”
By May, he had successfully cared for 70 patients. The case reports that he sent back to B.J. Palmer were characteristic of the range of disease processes typically seen by chiropractors. Chiropractic was born from medical failures.
He reported on one young lady with early stages of “consumption.” Symptoms were, “deep coughing, slight headaches and dizziness, sore throat, vomiting, specks in the eyes, hiccough and little temperature.” The analysis he describes is consistent with D.D. Palmer’s method of “nerve tracing.” Morikubo writes,
“I discovered subluxations at 2 and 4 dorsal, also 11 dorsal. From the 4th, on both sides, the tender nerves led almost perpendicularly toward the 6th cervical, from there it divided, one running to throat and lost in the flesh of the neck; the other turned downward and outward along the clavicle, from where it took straight course over 2-3 ribs then deflected toward outside 6-7 ribs, right into the diaphragm. The nerves on both sides were lost at the same point–diaphragm.”
“I adjusted 2-4 dorsal, and the distressing symptoms ceased almost instantly. Since then, four days ago, she did not cough. She is practically well now. She took three adjustments.”
Cases ranged from 1 visit to four months. Some other cases he took note of included a 49-year-old male with pulmonary tuberculosis, a 50-year-old female with “suspicious sputum,” and a 20-year-old male with “rheumatism,” with a paralyzed left arm, left facial paralysis, and full body convulsions. Examination of that last case “found a big axis sub-luxation.” Morikubo writes, “The patient drew up as straight as a pine tree: whirled around the left arm like a windmill and walked out of my office, like a hurricane.” The patient returned the next day “angry” because his cure was too quick.
Landmark Morikubo Case
In July 1907, the board filed a complaint against Morikubo. The landmark trial took place in August. The case demonstrated that chiropractic was a distinct profession with a science, art, and philosophy.
On January 1, 1908, Morikubo sent in several more cases to B.J. Palmer. He said the success of his cases was teaching him a great deal about the science of chiropractic. Also, that there were too many cases to include in one letter. And that he was growing so accustomed to successes that he was starting to take them for granted. He wanted to continue to document cases to push back against ignorance. Then he writes, “The future greatness of Chiropractic is simply immeasurable. In the meantime, I will live and die fighting against the medical trust and pseudo osteopaths.”
Take Action Today
Morikubo’s story is just one example of the many pioneers that D.D. Palmer inspired with his magnetic personality, his mastery of chiropractic, and ability to teach others what he knew. The ripples of his gifts are still with us today and yet the significance of their contributions is fading from the collective memory of the profession. This is contributing to the many challenges the profession faces.
To learn more please take the following actions:
- Join The Institute Chiropractic and master the three chiropractic paradigms.
- Get the new book Palmer Chiropractic Green Books: The Definitive Guide. (This book is transforming the knowledge-base of the profession.)
We are at a critical time in the chiropractic profession. A small minority in the profession have used their positions of power in academia, regulatory boards, and as journal editors and authors to try to move the profession away from its central defining feature, the analysis and correction of vertebral subluxation. This type of lexicon cleansing has been well documented. Not only do we need more articles in the literature documenting the correction and assessment of vertebral subluxation but we also need articles demonstrating the reality that vertebral subluxation continues to be the core of the profession.
The latest article by Dr. Dave Russell is a must read for the chiropractic profession as it establishes the current state of the profession in relation to vertebral subluxation. This includes insights about what still needs to be researched.
The article, The Assessment and Correction of Vertebral Subluxation is Central to Chiropractic Practice: Is there a Gap in the Clinical Evidence? was published in the latest issue of The Journal of Contemporary Chiropractic.
Here are some of the highlights:
- Vertebral subluxation has been central to the chiropractic profession since its inception, and is the basis for the profession’s identity
- Organizations external to the chiropractic profession such as the World Health Organization, Institute for Alternative Futures and Medicare (USA) recognize vertebral subluxation as as a core focus of chiropractic practice
- Though it would be impossible to know the thoughts of all practicing chiropractors, the available evidence does suggest the assessment and reduction/correction of vertebral subluxation is a central theme in clinical chiropractic practice, embraced by the majority of the practicing profession and chiropractic students
- Routinely the public report that they seek chiropractic care is to improve their well-being, beyond the “treatment” of musculoskeletal pain syndromes
- Clinical evidence does show great outcomes of chiropractic care relative to musculoskeletal conditions, non-musculoskeletal conditions and quality of life
- There are commonly use indirect or remote assessments that suggest vertebral subluxation causes alteration in biomechanical and neurological function, but don’t necessarily identify where and in what direction to deliver a chiropractic adjustment. These are reported on in the literature and important.
- Of primary interest in this study are direct indicators of vertebral subluxation, which include tenderness, soft tissue palpation, intersegmental motion palpation, joint play/end feel, leg-length inequality, and special tests including cervical syndrome, Derifield and heel tension, are commonly used in clinical practice, both as generic indicators or as part of specific technique protocols, are used in daily clinical practice to directly determine the site and direction to apply the chiropractic adjustment, and are consistent with the biomechanical and neurological attributes of a vertebral subluxation common to all models.
- Clinical evidence does not seem to reflect the core objective of vertebral subluxation assessment AND reduction/correction. In a review of all clinically oriented studies in chiropractic journals (2017) 70.2% described the assessment of vertebral subluxation using at least one of these indicators. In stark contrast, only 15.4% of the same studies documented a reduction, correction or “elimination” of vertebral subluxation based on the direct indicators documented after a period of care or a clinical trial.
- It is a shame that the very few in the profession publishing research seemed to have lost the core of what it is chiropractors do, and seem to have lost touch with the majority in the profession….It can’t just be assumed subluxation is corrected if we need to check for its existence in the first place, the same reverence should be given to the post care/trial assessment
- Chiropractors in clinical practice, chiropractic clinical educators and chiropractic researchers could address this potential gap in the evidence by documenting the commonly used direct indicators of vertebral subluxation in the initiation of care or a clinical trial and at each progress evaluation or post the completion of clinical trial outcome measurements.
Dr. Russell completed an in-depth survey of the literature including 199 references. The profession should study this paper and the references. Perhaps then we might begin to move forward with a more complete view of the profession and push back against the inaccurate portrayals about vertebral subluxation espoused from the fringes of the profession.
I wrote about my chiropractic legacy on my birthday last year. In that post, I reviewed the latest courses, TIC, some background about my previous writings, and an overview of my latest insights. I did not include the publications that were in the works or the newest research. It is amazing how a legacy can be multiplied in just one year!
This year truly marks a transformation for the chiropractic profession. I don’t say this lightly. The new book I just published with Timothy Faulkner and Joseph Foley is groundbreaking. It is the first time the profession might collectively understand The Palmer Chiropractic Green Books. So much is written about these books that is either derogatory or laudatory. Rarely do we get a dispassionate examination of the books. What is in them? Why are they still relevant to practicing chiropractors? What is the point of reading them? The book is a legacy.
As a tribute to this legacy, we are offering a limited coupon code for 20% off for the entire store. It is good until Feb 8, 2019. (We usually only offer coupons for TIC Members and select events. Legacy is a good reason to offer one!) Just type in: legacy
Also, in last year’s post, I did not mention the TEN new papers. We are now weeks away from publication. I am pleased to announce that they are coming soon. The papers will be published in the Journal of Chiropractic Humanities. They are in the final stage of layout and design. The topic is The Chiropractic Vertebral Subluxation from 1897-1997. I will do a series of blog posts about these papers and the courses they will inspire in the coming weeks.
Finally, the latest research is really powerful. Last year I started my PhD studies at the School of Health and Human Sciences at Southern Cross University. As I develop this research, I post regular lectures for TIC Members. It is a fascinating project and will surely impact the chiropractic profession (and other professions) for decades to come. I am forever thankful to the Foundation for Vertebral Subluxation for the opportunity.
As this 48th year of my life unfolds, I look forward to the many ways my legacy in the chiropractic profession will continue. I already have plans to present a keynote address and a workshop at BCC Lyceum and a 12-hour seminar in Paris. Two new sets of online lectures are being developed. I am open to where this goes next!
Thank you for your continued support whether you are a reader, a TIC Member, a student, or a colleague (or all of these).
May your year be bright,
I am continually amazed by the bias exhibited by chiropractors against B.J. Palmer. It rarely seems to stem from a critical analysis of the literature. More often it seems like a meme that was passed down from teacher to student or from author to reader. This short clip is from a longer Skype lecture that I gave to a chiropractic school class. In the clip, I just mention this weird phenomenon.
At the end of the clip, I added one solution to remedying this problem. The solution is simple – read the new book Palmer Chiropractic Green Books: The Definitive Guide.
Just to be clear, I did not try to sell the book to chiropractic students. I am more interested in teaching facts to students. They always need more historical facts. I did plug it here because after cutting this clip from the larger lecture I realized the simple solution to this problem.
I know it may seem like I am putting B.J. Palmer up on a pedestal. After all, that is how the traditional bias is portrayed. Anyone who seems to embrace the ideas or theories espoused by B.J. are often criticized in some way. This is how bias generally works. Groups of people are clumped together as if they all believe the same thing without a critical or – dare I say – evidence based attempt at understanding.
B.J. Palmer was a controversial figure. He created enemies and followers. One example is from his classic talk, Cleaning the House. It was delivered on July 16, 1922, at Wilcox’s Pier Restaurant, Savin Rock, in West Haven, Connecticut. During the talk, B.J. laid out the new UCA policy to take over state boards throughout the United States and push for the model legislation. The UCA legislation was designed to ensure that chiropractic was solely defined as the analysis and correction of vertebral subluxation.
This approach went against those in the profession who sought to expand chiropractic beyond its traditional boundaries. Those once referred to as “mixers” because they mixed chiropractic with various therapeutic modalities and even included other professions in their practice of chiropractic. He also attacked several heads of chiropractic colleges.
Think about how these attacks may have caused ripples throughout the decades. Students at these schools became the next wave of leaders in the profession. The students of their students are probably still in places of power throughout the profession, teaching, publishing, administrating, and establishing policies.
Basically, when I hear people shout negative things on social media about B.J. Palmer, I generally assume their teacher’s teacher’s teacher knew someone who had a disagreement with B.J. I rarely assume the person is well informed on the three types of chiropractic paradigms and the literature that supports them. Hopefully, they are.
Part one of the fifty-minute talk is available for TIC Members here: B.J. Palmer’s Evolution. In the talk, I explore the important facts that there are several different biases against B.J. Palmer. Some of these arise from D.D. Palmer’s writings (those need to be critically analyzed). Other biases involve misunderstandings about various aspects of B.J. Palmer’s theories such as the development of his upper cervical model of chiropractic.
There is also the decades of chiropractors that just accepted B.J. Palmer’s ideas. Some of whom studied his research and theories. Others may have just accepted the ideas on authority. This is not an excuse to lump all modern chiropractors into that category.
The Definitive Guide is a powerful way for the entire profession to learn the same basic content about the chiropractic paradigm, the Palmer Green Books, the evolution of the ideas, the decades of research, and interesting aspects of history. Many of the biases against B.J. Palmer will naturally dissipate as more and more chiropractors learn these facts.