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Dynamic Chiropractic – June 19, 1995, Vol. 13, Issue 13

On Hybrid Vigor and Creative Disaccord: The Panel of Advisors to the ACA Council on Technique

By Robert Cooperstein, MA, DC
My columns in Dynamic Chiropractic concern the American Back Society (ABS), an interdisciplinary organization that usually holds biannual meetings. Indeed, I largely devote my columns to these meetings. However, the ABS has decided not to conduct a Spring symposium this year due to the "recession in the doctor business," as one of its officers put it to me. Stripped of my usual raw material for an article, and not particularly eager to crank out one of those fluffy and all too predictable columns about MD/DC professional relations (or something like that), I decided to write about another very interesting organization to which I belong: the Panel of Advisors to the ACA Council on Technique.

The Panel of Advisors

The panel of advisors (panel, henceforth) to the ACA Council on Technique was created in the mid '70s to advise the council, and through that body the ACA Board of Governors, on matters pertaining to chiropractic technique. Although the ACA is obviously a chiro-political organization, which pursues an agenda that may be distinctly different from that of other chiropractic organizations, the panel is by definition apolitical. This means that any of its members, most of whom are instructors at one of the chiropractic colleges, may belong to or teach at a college that identifies, for example, mostly with the ICA. Although it may seem odd at first that outside-oriented individuals may wind up belonging to a group that advises the ACA, a closer look will reveal the inner logic of this arrangement.

The panel filters "all things chiropractic" for those elements -- granules, filaments, and loose bodies that bear directly on the practice of chiropractic technique. We meet twice a year to talk about these things, and plan the execution of various projects. I suppose it would be chiro-politically correct to say that we are a cohesive, tightly-knit group with a large degree of internal consensus on issues of fundamental importance to the chiropractic profession but that would not be true. We're just like any other group of 20 or so chiropractors that has been somewhat arbitrarily assembled, each of us selected for participation by the sponsoring institutions according to inconstant criteria, or having come forward from private practice for varied reasons. Those who attend any particular meeting represent a wide gamut of views: mixers, straights, soft tissue specialists, osseous traditionalists, master-clinician types, researcher-academics, private practitioners, professors of chiropractic, and maybe even an admitted medipractor or two. What a grab bag! Given this diversity, there is a surprising degree of agreement on many issues, and a less surprising measure of disagreement on others. Where others indulge in banal harmony, we mud wrestle with contradiction. The atmosphere is always collegial.

What can such a heterogeneous group accomplish? It can thrash out in a protected, supportive environment the same vitally important and often divisive technique issues that should concern most others in the chiropractic profession. It can formulate positions, reaching consensus more like a jury does than by taking votes, and it can initiate collaborative projects, based on the least common denominators that can be identified. Some of these actions bear fruit, some simmer, while a few others just wither on the vine. Although it would not be difficult to turn out a happy little article, expressing deep satisfaction and optimism about the doings of the panel, I just don't have it in me. I thought it might be more illuminating to open the drawer on some of the panel's slightly dirty laundry, in the hope that some of our more pertinent internal disagreements would appear relevant and provoke more valuable discussion among Dynamic Chiropractic readers than the cheery stuff.

[Fellow panelists: I hope you won't mind my directing some public attention toward some of our more problematic areas. "DC" readers: please don't misinterpret my willingness to "accentuate the negative" as anything other than an abbreviated field study in creative disaccord, a celebration of hybrid vigor.]

Invited Technique Representatives

For several years the panel had been inviting the generally acknowledged experts in various of the proprietary technique systems to present their work at our meetings. However, it was not entirely clear whether the goal was to critically evaluate these techniques, or perform the more descriptive task of merely cataloging them in a standardized, descriptive way. Some of the presentations clearly fell into the category of "mainstream" by any definition of the term, but others seemed more "experimental" (a euphemism for techniques that are somewhere in-between interesting-but-fringe and definitely whacked-out).

The panel could easily address the mainstream chiropractic procedures, but could not really agree on how to handle the more experimental stuff. Some panelists thought it necessary to identify the reasonable and possibly useful components of these admittedly strange procedures, while other thought it would be more fitting to identify propeller-and-beany-cap chiropractic for what it is. Did the panel have the resources to separate a few grains of gold dust from what may have been in certain cases a mountain of fool's gold?

I'm not sure that this disagreement was resolved, but at any rate the panel did decide to discontinue, at least for the time being, the practice of inviting prominent technique representatives to make presentations. The fact that one of the more controversial of our invited guests wound up on national television just a few months later, generating quite a bit of negative publicity for the profession (not due to media distortion, but by just doing his thing), proved very telling to some of the panelists. Any organization which remains fuzzy on its own rules of engagement with other organizations and individuals may wind up with its own credibility on the line.

Technique Overviews Project

The panel has also been engaged in describing the proprietary technique systems according to a standardized format, leading toward publications. Indeed, one of the important reasons for inviting the technique people was to gather information toward this end. One important track has consisted in the categorization of chiropractic diagnostic and treatment procedures that are common to many named techniques, rather than belonging to any one of them. This project has contributed toward the formulation of the widely-published "Bartol's Model" (Bartol KM. A model for the categorization of chiropractic treatment procedures. Chiropractic Technique 1991;3(2):78). Another important track has aimed at describing the named techniques as such, a track which generated some marked differences among the panelists as to how the project should best proceed. Some thought that the named technique experts should describe their own techniques, whereas others thought it preferable that more neutral panelists prepare the overviews. A few panelists saw no problem in publishing a collection that would feature both technique expert and panel-prepared reviews.

This issue of expert vs. panel-prepared reviews is really just a subset of a more fundamental issue: should the panel simply describe chiropractic techniques, or should it critically assess them? Although most of the panelists seemed to prefer a mostly descriptive project, a smaller but very vocal group of panelists very much wanted the technique overviews to be critical. (It should go without saying that in their lexicon "critical" did not necessarily mean "negative.") Appreciate the irony: some panelists objected to the technique overviews project because they feared it was becoming critical, whereas others complained because they thought it was not critical enough.

It took two or three meetings to work out the differences. The panel eventually concluded that the profession would be best served by technique overviews that had been prepared by its own members, to minimize the bias that proprietary interests inevitably introduce. We sent out a letter thanking those technique representatives who had already visited our meetings, or who had submitted written materials to us, but advising them that panelists themselves would write and take full responsibility for all the overviews. I personally have been appointed to edit the project, and mandated to make sure that the tone is largely descriptive, somewhat analytical, and perhaps a little critical here and there. The individual chapters are sent out for review to all the panelists, and to the technique representatives as well. Some of the overviews have already been published in Chiropractic Technique, and others are expected to appear in future issues. The panel highly recommends that chiropractors subscribe to this valuable publication, and only partly because some of its own members frequently publish there.

What Is Diversified?

Among the chapters completed to date in draft form, only the one on diversified technique aroused much group controversy. Each chapter portrays a given technique system in a standardized format: Name of Technique, Statement of Intent, Overview, History, etc. When work began on the diversified chapter, it rapidly became clear to the author (yes, to me) that what is meant by the term "diversified" has undergone both temporal change and been subject at various times to diverse interpretations by different individuals. I jettisoned the standardized format that had proven to be so serviceable for the clearly identified technique systems, such as Gonstead and SOT, in favor of an historical essay form. I took the position that diversified is a technique system distinguished from the ensemble of the others, however paradoxically, chiefly by its poor distinction from any individual one of them.

This proved to be very controversial, requiring a long discussion that led to each panelist being polled on the following question: is diversified a clearly defined technique system parallel to the others, capable of being treated as such; or is diversified a fairly loosely defined umbrella term for what amounts to generic technique, not capable of being succinctly and uniquely described? This very spirited discussion did not lead to any consensus, and no doubt will be resumed in the future. In any case, the historical essay on diversified itself is submitted for peer review and is likely to be published later this year.

State Technique Symposia

The ACA Council on Technique, with the support and assistance of several of the panelists, has mounted symposia in Wisconsin, Washington, and Pennsylvania, with an emphasis on what may be called comparative chiropractic technique. Invited spokespeople for the various system techniques explain and demonstrate how they address various clinical problems, as presented by a moderator from the panel. It is likely that there will be more such symposia in the future, in that several of the State Associations have expressed interest in this type of presentation.

There has been much lively discussion at panel meetings on how these technique symposia are being conducted. Some Panelists have objected to the present symposia format, in which the invited guests are pretty much free to showcase their technique as is, and would prefer that the symposia more explicitly encourage "critical thinking." They would like to see the systems technique developers more challenged, in particular from a generic technique point of view.

Other panelists are more in favor of continuing the symposia in their present format, which in their opinion adequately serves the doctors and students who attend. They feel that it has been both interesting and useful that the symposia be clinically-oriented and contain an ample hands-on component. They do not want to dilute this functionality with what they anticipate would comprise a more academic, pedagogic slant, were the "critical thinking" theme to become more explicitly implemented. This discussion is far from over.

The Technique Question

As should be abundantly clear by now, there is a common thread that runs through most of the issues that engender debate in the panel. There is no consensus on how to clearly distinguish mainstream from fringe chiropractic technique, and thus no consensus on how to bring this matter before the chiropractic profession and other interested parties. No big deal, it's just the technique question. As for the panel, we are the melting pot of chiropractic -- and proud of it.

Robert Cooperstein, DC
American Back Society

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