Preparing a response offers two significant challenges: 1) addressing their criticisms of my thoughts and giving my perspective on their ideas; and 2) avoiding a deluge of intellectual and philosophical sparring that will either not interest or disgust the readership of Dynamic Chiropractic.
A Response to Their ResponseCriticism: Dr. Phillips calls for a segregating of science-based intellectual chiropractors from faith-based fundamentalist chiropractors. This course of action cannot and never will unite the profession.
Response: My intent was to focus on two reasons why this profession remains a divided profession rather than a call to segregate as Drs. Stern and Black suggest. A mixed opinion on pre-professional training standards and a negative attitude towards new knowledge are two areas of thought that have and will continue to divide the vision of the chiropractic profession. My comments raised the issue in hopes of drawing others into the solution-making process.
Drs. Stern and Black argue the need for a dichotomous (double-sided) profession based on the strengths that each perspective provides to the other. They site the Wilk case as evidence of intellectual weakness within the profession and the survival of the medical conspiracy as evidence of strength supported more by faith in the profession than by intellectual evidence. Their position is, "We must recognize, first of all, that the profession needs both camps."
Their reference to examples from the history of science where dichotomous thoughts converge and conflict demonstrates what appears to be a fundamental principle of "... opposites in all things." I concur with the value of opposites that are complementary to each other (breathing in and breathing out as suggested by Drs. Stern and Black). There is strength to be gained from the convergence of the intellectual sector of our profession with our vitalistic heritage.
The real challenge for chiropractic (and many other systems of thought that struggle with the issue of faith and science) is blending the strengths of both camps. To be of an intellectual vent (i.e., to question the fundamentals of one's beliefs) does not require a lack of faith, although such a position is often construed to be so. In a religious order, to question the fundamental tenets is to be a heretic. In the field of science, to question fundamental beliefs is to be admired and encouraged. What do we do in chiropractic?
Drs. Stern and Black draw attention only to the strengths of the diversity of thought. To be fair, shouldn't we also ponder the weaknesses associated with such diversity? By weakness, I refer to where differences are more contradictory or in conflict rather than complementary (i.e., breathing clean air as compared to breathing air contaminated with pollutants and particulate matter such as being in a poorly ventilated smoke filled room).
Has the prevailing anti-intellectual, anti-scientific, anti-research attitude (usually associated with the faith-based fundamentalist) served the best interest in the development and advancement of this profession, Drs. Stern and Black? Would this profession be more socially accepted and more integrated into the mainstream of health care if we had adopted an attitude that encouraged scientific investigation early in our first century of existence? Wouldn't our future as a profession be more firmly entrenched in the minds of society if we had adopted a course of research and discovery as did allopathic medicine? I share the thoughts of an historian:
"When homeopathic and eclectic doctors were shunned and denounced by the regular (allopathic) profession, they thrived. But the more they gained in access to the privileges of regular physicians, the more their numbers declined ... Homeopathy had one foot in modern science, the other in pre-scientific mysticism; this became an increasingly untenable position. While regular medicine was producing important and demonstrable scientific advances, homeopathy generated no new discoveries."2
The decline of homeopathy went from 22 schools in 1900 to zero in the next several years.3
Drs. Stern and Black and I probably agree on the value and importance of a strong belief in what we do and what we are as doctors of chiropractic. I would hope that similar agreement exists on the importance of a strong pursuit of scientific investigation, not to prove chiropractic works but rather to gain a better understanding of what happens when chiropractic care enhances the health and well-being of a patient. Where differences in the profession are complementary to each other, they should be encouraged and supported. Where differences are in conflict and destructive, a harmonious relationship seems incompatible.
Criticism: Dr. Phillips calls for greater regulatory control to force the profession to accept higher standards of education.
"I know of no safe depository of the ultimate powers of the society but the people themselves; and if we think them not enlightened enough to exercise their control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education." -- Thomas Jefferson4
Response: The sweeping generality in the article by Drs. Stern -- "fundamentalists typically favor individual choice" and "Intellectuals, on the other hand, by virtue of their trust in scientific knowledge (which experts are presumed to possess), typically favor regulatory control ..." -- is designed to dichotomize the argument regarding regulation into simple opposites and sets the stage to argue in favor of adopting a "balance of power." That is, there is a need for both regulatory control and individual and institutional choice. The position of accepting "both camps" is proposed again.
I must stand with Thomas Jefferson on this issue as I assume Drs. Stern and Black do, since they quoted him in their article. We must inform our profession of the value of education. While no individual or institution will argue against the value of education, how one defines, implements and evaluates the teaching/learning process can be fraught with diversity, deception and divisiveness. The standards set by CCE are not imposed by the government as much as they are self-imposed by the profession. Most accrediting agencies are self-selected and self-governed by their own constituents. But if we are going to support individual and institutional choices over regulation, why do we need a CCE or any other standard setting body?
Drs. Stern and Black ask the question, "What harm has the profession suffered by graduating students who entered chiropractic college with GPAs between 2.25 and 2.49?" The issue is not the points of a GPA. This question could be retorted with, "Could the profession have been better served by only admitting students with a GPA of 2.5 or higher?" I don't know the answer to either question. What we should be asking is, "Will our patients be better served as the level of education of doctors of chiropractic is increased?" If the answer is towards the negative, then to what end does the two-year pre-professional requirement serve, or why do we even need educational standards? Let's carry it to the absurd and question the value of educational institutions as opposed to simple apprenticeships.
Do we need a two-tier degree system? In some areas of the world they already exist. What are we going to do in the U.S. with respect to holding educational standards to the status quo, increasing standards or decreasing them either overtly or covertly? The "balance of power" for the United States, as discussed by Drs. Stern and Black, rested in the hands of wise men who sought the benefit of the nation over self-benefit. Can chiropractic muster such statesmen who can subsume self-interest to the benefit of the profession and the patient? How can we rely on the wisdom of Thomas Jefferson when within the ranks of our leadership, the will to educate the profession to a greater level of enlightenment is called into question?
I ask Drs. Stern and Black, prominent members of Parker College of Chiropractic, if CCE were to remove the pre-professional standard of any GPA, would students admitted to the Parker College continue to carry at least a 2.25 GPA, or would the level decrease or increase? We have answered that question at LACC. We have already raised the bar to a 2.5 and intend to lift it higher.
Criticism: Dr. Phillips places a higher value on knowledge gained from scientific experiment than clinical experience.
Response: While this criticism is not so stated, it is implied in the closing comments of Drs. Stern and Black. I encourage their work in accumulating a data base of information regarding the experience of clinical practice. This is a scientific process and can provide valuable information for the benefit of our patients and the profession.
They paint a dichotomy and then proceed to blend the positive aspects of both camps together. Learning in one camp to the exclusion of the other is unacceptable. Learning by experience and learning by experiment must form a cohesive knowledge base from which theories and hypotheses can be derived and tested. As long as we are willing to question and study our theories and hypotheses, we stand on firm ground.
The two camps in the dichotomy become combative when one says it has no need for the other. When we deny the need for science because our experience has already taught us "that it works" or when we deny the need for experience on the basis of our experiments, we have disrupted the delicate balance between faith and knowledge.
I thank Drs. Stern and Black for their thoughts. Dialogue is a healthy enterprise from which all parties can benefit. I believe we are both seeking the solution to a dilemma. A divided profession is a precarious profession. A profession united on standards and principle but diverse in theory is a healthy profession. We need to define the standards and fundamental principles around which we can unite. Our vision of the doctor of chiropractic as the health care provider in the 21st century is a common principle around which we can all unite. The attitude toward standards by which the doctor of chiropractic of the next century will be admitted into our profession divide us. Failure to resolve these attitudes sustains and feeds the division of the vision that already exists in the profession.
- Division of the vision, Dynamic Chiropractic, 14 July 1997.
- Starr P. The Social Transformation of American Medicine. Basic Books Inc., NY, 1982, pp. 107-108.
- Ibid, p. 107.
- Thomas Jefferson, letter to William Charles Jarvis, September 28, 1820. Presidential Papers of Thomas Jefferson, Library of Congress, Washington, DC (1944), microfilm series I:1820-22. (Quoted by Drs. Stern & Black.)
Reed B. Phillips, DC, DACBR, PhD
Los Angeles College of Chiropractic
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