Surveys Now and Then
By Joseph Keating Jr., PhDIt's a human trait that we are not always consistent in what we say, and what we say and do don't always match. Words and actions may differ, which sometimes creates more problems than overt behavior. For example, it was D.D. Palmer's words, his published claims to cure "dis-ease" in The Chiropractor (magazine of the Palmer School), rather than his actual practice of chiropractic that resulted in his arrest, conviction and jailing in Scott County, Iowa in 1906. Similarly, in modern times, it is often the claims made for the chiropractic healing art (e.g., Grod, et al., 2001; Keating, 1988; Keating and Hansen, 1992), rather than the performance thereof, which creates problems for the profession. The simple wisdom of C.O. Watkins, DC, that we balance our boldness in devising novel methods of healing with caution in making claims to the public, often eludes the profession.
The disparity between chiropractic rhetoric and the actual beliefs and practices of the rank and file was driven home recently in an apparently random survey of 687 North American DCs (New, 2003). Bannered in the June 2, 2003 issue of Dynamic Chiropractic as "New Study Finds Unity in Chiropractic," the survey actually found consensus, rather than unity. There was considerable agreement about a number of clinical practices, although participants apparently diverged in how they identified themselves "philosophically"; the investigators allowed a three-category, self-classification scheme: "broad-scope" (mixer), "middle-scope," or "focused-scope" (straight). Although many American members of the profession continue to partition themselves politically (e.g., the American Chiropractic Association, the International Chiropractors Association, the National Association of Chiropractic Medicine, and the World Chiropractic Alliance), with the majority belonging to no national chiropractic organization (!), the survey reveals there are clear majority views and preferences.
Frankly, this is not news, as this most recent survey parallels, in some respects, studies conducted in 1928 (by the Research Bureau of the ACA) and in 1930 by the Lincoln Chiropractic College. Although the issues addressed in these earlier investigations do not always match up with those of the McDonald, et al., report, there is enough overlap to make the comparisons interesting. It is important to remember that once upon a time, straight chiropractic was the apparent majority view (certainly the "politically correct" stance) among doctors of chiropractic. "Subluxation" and its meaningfulness or appropriateness of terminology was not questioned.. Even so, times were changing, and chiropractors 75 years ago often seemed comfortable with a "greater than subluxation only" approach to the healing art. Additionally, the use of more than adjustive methods was the primary distinction between mixers and straights in that earlier era.
The ACA study (Survey, 1928) was conducted by Leo J. Steinbach, DC, dean of the Universal Chiropractic College (UCC) in Pittsburgh and director of the ACA's research bureau. (This earlier ACA was a precursor to the National Chiropractic Association, which, in turn, is the forerunner of today's ACA.) The survey methodology of 1928 would surely not pass muster today, but was a novelty in the profession at the time. No inferential statistics were employed; the appropriate statistical tests may not have been available in that earlier era. Steinbach noted that the survey questionnaire had been sent to 500 "representative chiropractors chosen from five separate lists." How the 500 were selected is not clear, and there was a disproportionate inclusion of UCC graduates in the final sample. (The overwhelming majority of chiropractors in 1928 were Palmer alumni, who are underrepresented in the final sample; see question #1 below.)
Steinbach informed readers of the Bulletin of the Research Bureau of the ACA that 302 DCs had returned the survey form, in various degrees of completion. Steinbach also stated that the letter accompanying the survey gave "the standard definition of chiropractic... a system of adjusting the segments of the spinal column by the human hands only for the cure of disease" (Survey, 1928). The UCC dean then indicated, "Those employing other methods, in addition to the above, to restore the sick to health, are listed as 'mixers.'"
The questions and answers received from this 1928 ACA investigation are reproduced here:
1. Of what chiropractic college are you a graduate?
2. Do you practice straight chiropractic, exclusively?
65 answered in the affirmative; 237 answered in the negative.
3. If not, what supplementary methods do you use?
4. Have you ever received instruction in other methods?
208 answered in the affirmative; 94 answered in the negative.
5. As a straight chiropractor, is your practice increasing, or not?
30 stated that it is increasing; 20 stated that it is decreasing; 15 stated that it is stationary.
6. Do you believe the employment of other drugless methods is an aid or detriment in the practice of chiropractic? Give reasons.
239 believe the use of other drugless methods to be a distinct aid for the following reasons:
60 believe the use of other methods to be a detriment for the following reasons:
7. Have you ever employed other methods and later discarded them and returned to straight practice? Give reasons.
14 replied in the affirmative, giving the following reasons for their action:
8. From your observation, would you say that "mixers" have a larger clientele than "straights?"
201 stated that "mixers" have the larger clientele.
14 stated that "straights" have the larger clientele.
80 stated that neither had any advantage.
7 were noncommittal on this question.
9. From your observation, is chiropractic gaining or losing public confidence?
224 stated that chiropractic is gaining.
69 stated that chiropractic is losing.
9 failed to answer this question.
10. What is the general opinion of chiropractic in your community?
180 stated that it is good; 88 stated that it is fair; 34 stated that it is poor.
11. Do you think that chiropractic colleges should instruct their students in other drugless methods?
243 answered in the affirmative; 59 answered in the negative.
12. Do you believe the successful chiropractors of the future must also include other drugless methods?
238 answered in the affirmative; 64 answered in the negative.
13. Did you begin practice as a "straight" and then later include other methods or adjuncts? Give reasons.
154 answered in the affirmative and cited the following reasons:
14. In your opinion, what is the greatest need in chiropractic today?
97 percent of those replying consider all or part of the following to be the greatest needs confronting the profession today:
Reprinted in one of the early histories of the profession (Turner, 1931), the Lincoln College's apparently nonrandom sample of more than 1,800 DCs found consensus among practitioners in matters of diagnosis, and divergence in matters of nonadjustive therapeutics. The Lincoln, established at Indianapolis in 1926 to provide an alternative to the Palmer School (Keating, 1990, 1998), did not teach physiotherapies, and so was considered a "straight" chiropractic school, with an above-average commitment to rigor in teaching the basic and diagnostic sciences. (Unfortunately, the original report of the Lincoln survey is not available to this author, and its republication in Chittenden Turner's The Rise of Chiropractic does not indicate how the sample was chosen.)
The following are the results of a survey conducted
There have been a number of surveys of opinion and practice among chiropractors during the past 70 years, some conducted from within the profession (e.g., Chiropractic, 1962), and some by outside observers (e.g., Stanford, 1960). Recognition of the commonalities among DCs has an equally long history, as suggested by the plea of Carl S. Cleveland, Sr., D.C. and others in the 1930s: "Unity in essentials - liberty in nonessentials" (Cleveland, 1933). Then, as now, however, chiropractors do not always agree on "the fundamentals," and when they do (e.g., the meaningfulness of subluxation), a willingness to make claims beyond what the scientific literature justifies, claims that grate on the ears of the scientific community, seems to sustain the profession's historic ostracism. This willingness bespeaks the diversity of epistemologies in the profession (Keating, 1989; 1993), an issue of philosophy that has rarely been addressed by the profession.
So, what may be gleaned from this cursory consideration of surveys then and now? Beliefs and practices do change in chiropractic, albeit sometimes rather slowly. There has probably always been consensus (clear majority opinion) on some issues of concern (e.g., diagnosis, the validity of subluxation), although some bases for agreement have changed over the years (e.g., appropriateness of physiotherapeutics). Simplistic, dichotomous (or even trichotomous) labels such as "straight" and "mixer," although long part of the jargon in the profession, misrepresent the complexity and diversity (Keating, 1992) of opinions that DCs hold.
And as ever, a good deal more research is warranted.
Note: The Association for the History of Chiropractic (AHC) will hold its April 2004 Conference on Chiropractic History will be held in Mexico City in March. Details about the upcoming conference can be obtained by checking the AHC website at www.chirohistory.org.
Joseph Keating Jr., PhD
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