Something New under the Sun
By Joseph Keating Jr., PhDI've been exploring one of the turning points in chiropractic history: the 1935 convention of the National Chiropractic Association (NCA) the predecessor of today's ACA. It's largely been forgotten, but this was the 40th anniversary of D.D. Palmer's development of chiropractic and the 90th anniversary of his birth. The NCA pulled out all the stops to celebrate the occasion (Rogers, 1935). The convention, held in Hollywood, attracted 2,000 members of the profession, a staggering 14 percent of the entire chiropractic population of the day (Lee, 1935), estimated at a total of 14,000 in North America (Schulze, 1935).
The mid-30s were trying times for the profession. The nation-wide depression had devastated personal finances, organized medicine was escalating its efforts to eliminate chiropractic by introducing basic science legislation, chiropractic colleges were closing, and the battle among "straight" versus "mixer" chiropractors was as bitter and intense as it ever would be. Although the formal split between these two camps over the extent and content of chiropractic education was still a few years in the future (see Keating, et al., 1991), the deliberations at the Hollywood meeting can be seen as a choice point for the broad-scope vs. fundamentalist chiropractors.
In many respects it was the deliberations at the 1935 NCA convention which would shape the next 50 years of the chiropractic saga. It was there in Southern California that the NCA's Committee on Educational Standards was created, the precursor to the Council on Chiropractic Education (CCE). The year 1935 was indeed the "Crossroads" implied by C. Sterling Cooley, DC, in his featured address to the organization (Cooley, 1935, a&b). During the subsequent six decades, the dispute over standards of chiropractic education and practice has continued, and, undoubtedly, we have not heard the last of it. Passions and convictions on both sides of the issues were and are intense, and seemingly will not admit to rational dialogue nor compromise.
To be sure, there were in that earlier era, as there are now, areas of significant agreement among chiropractors. For the most part, DCs continue to perceive themselves as an autonomous provider group which emphasizes conservative health care. The overwhelming majority of chiropractors in 1935 saw manipulation as the mainstay of their armamentarium, although the range of methods and of health problems addressed by chiros in that forgotten period was probably broader than today. No less importantly, chiropractors then as now often perceived publicity as a major, if not the major unmet need of the profession. The story of chiropractic in the late 1920s through the 1930s is replete with repeated attempts to mount nationwide advertising campaigns to "get the chiropractic story out" to the public and to counteract the deleterious effects of anti-chiropractic propaganda. Shades of Reader's Digest and the Centennial Foundation's "informercials!"
Yes, as I chew over the details of those momentous events of yesteryear and try to form a mental image of the Hollywood meeting, I note some important differences. Although the nature of the contentions between the extreme ends of the chiropractic spectrum have not changed (e.g., should DCs be trained to diagnose or merely to detect subluxations; what part should nonadjustive methods play in the role of the DC?) a new element has been added. Today, chiropractors have had a taste, just a sampler, of the positive press that can result from serious scientific investigation. Reports of controlled clinical trials and consensus panels such as those conducted by the Consortium for Chiropractic Research and the RAND Corporation (e.g., Shekelle, et al., 1991) have produced a willingness among journalists and others to rethink the traditional prevailing wisdom that chiropractic care is health fraud. To be sure, the sustained willingness in some corners of the profession to perpetuate extraordinary and scientifically unsubstantiated claims for the value of chiropractic methods (e.g., ACA, 1993) continues to provide an irresistible impression of chiropractic as quackery. Despite the profession's tolerance of gobbledygook, the preliminary controlled data on chiropractic outcomes has impressed a few who might otherwise be counted as hard-core chiropractic skeptics.
Undoubtedly there are some in the profession who will insist that the conspiracy to develop a genuine science of chiropractic during the past decade is futile, if not subversive, and that we ought not to capitulate to medicine by engaging in science. After all, we know "it works," just like we've always claimed, and research is inherently medical. Chiropractic simply is, "enuf said!" I too hesitate to discuss the small but meaningful progress in the knowledge base, since so many in the profession are all too ready to exaggerate research findings for the sake of marketing (e.g., FCER, 1991). Others mistakenly believe that public relations (rather than patient benefit) is the primary reason for chiropractic scientific studies, rather than a worthy secondary goal. Although this is indeed significant progress over the view expressed at the NCA convention in 1935 (to wit: that advertising is "the guarantee" of the quality of chiropractic care; Slocum, 1935), such attitudes will not sustain professional commitment to continuing scholarship, and risk jeopardizing the budding science of chiropractic.
In his address to the NCA's Hollywood convention in 1935, the about-to-be-elected president, C. Sterling Cooley, DC spoke of the profession as having reached a crossroads from which three paths led: one to oblivion, a second to "another 40 years of 'wandering in the wilderness' of uncertainty, persecution and chaos," and a third which "leads to a land of promise -- where truth rules supreme" (Cooley, 1935a). In fact, the path chosen by the NCA at that momentous meeting was not what anyone anticipated.
Some 40 years later, the commitment made in Hollywood to improve and standardize chiropractic education to overcome the threat of basic science legislation, eventually led to CCE's recognition by the U.S. Office of Education. The decision to improve basic science education did not involve any willingness to consider the effectiveness of chiropractic methods. Moreover, later prompting to introduce clinical research training to the curriculum (Watkins, 1948) were rejected by the broad-scope rationalists who pioneered the basic science improvements (e.g., Budden, 1948). The chiropractic profession's commitment to basic science came at the expense of the development of the clinical science of chiropractic.
This pattern may now be changing. Something novel is visible in chiropractic today: legitimate clinical science, not much perhaps, not enough to meet the new challenges confronting chiropractic in this age of accountability in health care, yet there is at least the possibility that chiropractic may now find its way out of the wilderness of scholarly apathy and anti-intellectualism (Coulter, 1990), pseudoscience (McGregor, 1993; Nelson, 1993), and anti-science (Keating, 1993). The profession today has the capacity to chart a course toward greater professionalism and thereby greater recognition and acceptance in society and among other health disciplines. There is something new in chiropractic, but it's up to chiropractors to grasp and shape and propel it.
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Joseph C. Keating Jr., PhD
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