A Tale of Two Professions
From the perspective of the longest serving president in the history of chiropractic education, Dr. Gerry Clum, two recent research articles perfectly illustrate the “split personality” exhibited by the chiropractic profession.
One of these two recent articles essentially (and rather pejoratively) concludes that it is delusional to suggest chiropractic care has any role other than pain relief in cases of simple back and neck pain.
The other article describes a significant finding which, as Dr. Gerry Clum put it in the video below, demonstrates that “one single adjustment has the ability to produce central nervous system change that yielded a 64% improvement in muscle strength in…post stroke patients,” which suggests chiropractic adjustment provides benefits that are far more wide ranging than simple pain relief.
That’s quite a wide perspective for a single profession to have when viewing itself…and creates a chasm that is both unnecessary and detrimental to the profession.
Click on the video below for an episode of “33 Minutes,”* in which Dr. Gerry Clum is interviewed by Dr. Jason Deitch – and discover the relative merits of these two articles.
Scroll down to find a transcript of the video posted below.
Clum: Good afternoon. How you doing?
Deitch: I’m doing well besides staying dry here in northern California these days. I’m doing really well and I’m really excited for today’s conversation. There’s been a lot of activity on all kinds of topics I think that are extremely positive for our profession. But what we want to talk about today is some research, recent research, that has come out that has some lessons for us to understand, analyze, think through, learn from, because I am seeing a lot of different trends that I think all spell out lots of hope for our profession. If we can learn from our past, be smart about what we’re seeing going on right now, and really build and follow a strategy to grow in the future, share what is some of the research that’s come out and, and let’s dissect it, deconstruct it and learn from it.
Clum: Thank you, Jason. They’ve been a fascinating couple of weeks in that regard. There’ve been two papers that have been released over the last couple of weeks. One was out of a study based in France with students at the French chiropractic program that was reported in an Australian journal. And the other was work that was completed in Pakistan by the Centre for Chiropractic Research at the New Zealand College of Chiropractic that was reported in a very high impact journal that’s a part of the Nature of family and we’re all familiar with Nature and the specific Journal of Scientific Reports that carried this article that was released, I believe it was just yesterday. So, these are two very timely papers. And let me begin by, by going over the title of each and then we can maybe spend a few minutes going into a little bit of the content and go from there.
Clum: The first, the paper that was the product of an analysis done on third year and sixth year students at the French institutes, both in Paris and in Toulouse, is entitled “Chiropractic conservatism and the ability to determine contraindications, non-indications and indications to chiropractic care, a cross sectional survey of chiropractic students.” So, what this article has done is basically lay out the landscape of the profession as being very bi-modal, that there are – and I’m going to use terms that are going to sound very pejorative, but they reflect the article – but there’s going to be a “legitimate” chiropractic perspective that deals with musculoskeletal pain and essentially a historical, old timey, and they use the word “conservatism,” not in the political sense, but in the traditional definition for the Oxford dictionary, talking about hanging on to old ways. You know, it’s very much a negative connotation, but let’s be candid about that.
Clum: So, they’ve got this dichotomized view of the profession where we’ve got the “legitimate” musculoskeletal people, the subluxation folks, the conservative folks – they didn’t use the word, but I’ll use the word – “illegitimate” folks on the other side of the aisle that would see a role for chiropractic beyond musculoskeletal care. And they’ve evaluated the ability of students given a series of cases and questions to say, “That patients should not be adjusted; that patient should be adjusted.” And this group in the middle, the researchers have said there’s no indication to adjust them. And these are persons with asthma, children with bedwetting problems, uh, persons with a middle ear, inner ear infections, and so on, things that there is literature for, and that there has been chiropractic experience with, but they’re non-musculoskeletal. And this group is saying that there are non-indications for care. And what does non-indication for care mean? Well, you don’t touch them is what it means.
Deitch: So, am I to understand that that is purely based on the symptomatology, not necessarily of any spinal analysis whatsoever.
Clum: Absolutely. It’s totally on symptomatic presentation. And to take it one step further, that’s a great point you brought up. The idea that somebody who is asymptomatic would be adjusted, would be an absolute non-indication to this group. Therefore, maintenance care, for example, would be a non-indication for care.
Deitch: So, is it fair to just sort of make the analogy or metaphor that it would be the equivalent of applying rules to a cardiologist that you wouldn’t give a medication unless they had a symptom. Of course, with heart disease, the number one symptom over 50% of the time, it would be a heart attack. That would be the proper time to give them the medication because they’ve got symptomatology expressing such, right? May sound like an extreme…
Clum: Um, yes and no. But, let me just go back to one of the other points that they’ve talked about here. They go as far as to suggest, and I want to read this because it was astonishing, because they’re suggesting that persons who adjust individuals in this non-indication category may be breaking the law – not going against standards, not going against their opinion, not inconsistent with the literature – breaking the law. You know, that’s the lead paragraph in the background of this discussion.
Deitch: Can we get a link? Just so everybody can see…put it down there? [Ed. postscript: Yes. Click here]
Clum: Let me read the whole paragraph.
Clum: “In countries where chiropractic is regulated by law, it is generally accepted as a profession…that deals with musculoskeletal conditions. Therefore, chiropractors working in such jurisdictions who also claim to prevent or treat non-musculoskeletal conditions may break the law.” Now the premise, and the conclusion that they say is generally accepted, that’s an opinion piece that came from the European Chiropractic Union. So, based upon their, the European Chiropractors Union, view of chiropractic in Europe, they have concluded that persons who are adjusting people in this non-indication category may be breaking the law. Taken to the ultimate extreme, their conclusion is that students who hold a broader view of chiropractic care other than “straight”…um, bad use of words… other than specifically musculoskeletal care, have a character flaw and the curricula need to be developed to teach this out of them and rectify this horrific problem for the profession and its future.
Clum: I mean, this is so bizarre in terms of what’s going on. They acknowledge that wherever…regardless of where people fall on the spectrum of subluxation, of being conservative in their terms, or not conservative, they recognize the contra-indications to care. They recognize the indications to care, both with considerable efficiency on both ends of the spectrum, but it’s this category in the middle that they don’t fully recognize. And the more subluxation-oriented you are, the more you appreciate the body’s ability to do its own healing, the more deviant you are from the musculoskeletal model consideration.
Clum: Now it’s really kind of fascinating because it builds upon, you know, lots of soft words: would, could, appears, perhaps, might be, et cetera, that gives a lot of squishiness to the article. But if you don’t read it from that perspective of appreciating the squishiness of some of those words and the implications, and you accept each sentence building on the next, you know, you create this and invite this environment where breaking the law becomes something to even think about in this context… You know, there’s no consideration whatsoever being given for a matter of professional judgment, a matter of personal experience. There’s no consideration being offered that perhaps the student who holds this view of the power of an adjustment had a profound experience under chiropractic care themselves and it’s their own experience, created their own worldview that’s informing them professionally. But we need to “train that out of them.”
Clum: So that’s the first article. The second article came out yesterday [Ed. note: February 25, 2019] and it came out in the Journal of Scientific Reports. The lead author is Kelly Holt from the Chiropractic Research Center in New Zealand, and it’s entitled “The effects of a single session of chiropractic care on strength, cortical drive, and spinal excitability in stroke patients.” Now, this was just released in Scientific Reports as I’ve said, and that Scientific Reports is a member of the Nature family of journals and it’s a very high impact journal, and I don’t want to get into dissing one journal versus the other, but Scientific Reports is way up the food chain in comparison to Chiropractic and Osteopathy out of Australia. No disrespect…meant, but you know, it’s just the way it is. They [Nature’s Scientific Reports] are a far more impactful journal in this world and that, that world of evidence. So what did Kelly and his colleagues in New Zealand come up with?
Clum: First of all, this study was done in a hospital setting in Pakistan. These are post stroke patients that have had a stroke that affected one of their lower limbs at least three months ago. So, they’re reasonably stable and where they’re going to go in terms of the effects of the stroke have settled in and they’re looking at assessing the plantar flection strength in these patients and the changes in it as a significant element to mobility and motor control and so on. After one single adjustment, there was a 64% improvement in strength.
Clum: One single adjustment – and Kelly and his fellow authors in this lay out the reasoning behind this in terms of the neurology that this is…showing a v-wave change as opposed to an h-wave change. The h-wave change is going to imply lower spinal circuitry. The v-wave change…implies supra-spinal involvement. So this is a change in the brain affecting this change in the ability fo the brain to drive that muscle following the adjustment, further strengthening the chain of evidence that Dr. Haavik from New Zealand and her colleagues have put on the table that have developed this premise about the neuroplastic effects of chiropractic care and the ability of an adjustment to produce changes in the brain, particularly the prefrontal cortex.
Clum: So, we’re talking about a 10-day window here, where we’ve got one perspective that says, if you would think about adjusting somebody for a non-musculoskeletal reason, you’re a deviant in the deal – to another perspective that says one single adjustment has the ability to produce central nervous system change that yielded a 64% improvement in muscle strength in these post stroke patients. Now, if we think about the whipsaw nature of this, it’s…you know… I remember an old joke about…kissing a sheepdog. It said you had to be very careful because you didn’t know which end you were kissing. You know, it’s, it’s just that kind of rapid back and [forth]…you gotta be kidding me…
Deitch: It sounds like the common breaking news on various stations that are as polarized as this.
Clum: I hadn’t thought of it in that context, but that’s exactly what it is…and, you know, and with all the moral judgment of it… You just don’t think differently. You just didn’t come look at a set of facts and come to a different conclusion. You’re a bad person. You know, you’re a law breaker, you know, and just injecting that kind of of hyperbole in this is just fascinating, fascinating, in terms of what it means and the desire to effect control. You know, if you take the time…both of these articles, by the way, are public, are open source articles, so they’re readily available. Anybody can download them and we’ll provide them with the links to both of them in this context, I’m sure. But when we start to look at these and we think about the implications of a central nervous system change as a result of an adjustment versus this “we only treat pain model” of chiropractic care, I could turn this around and say it’s almost malpractice not to adjust that patient that you call non-indication to deny them the opportunity for what could be the change that they need in their life.
Clum: Now, did we say that everybody in that non-indication category is going to improve under care? No, I don’t think anybody who provides healthcare of any kind makes that kind of statement with a straight face. Nobody’s got 100%, okay? I’m hoping that you and I can take the next couple of sessions that we do with 33 [Minutes series], and I really want to dig into each of these articles and I want to break them down and develop a set of slides that will talk about the content of them and not just rely on my memory and my interpretation. Let’s look at the words together and then, you know, let’s try and understand what would be the motivation behind somebody to write and assemble the information in one fashion or another? What would be the… You know, what’s going on and what’s being served in each of these approaches that are being taken and see what we can come up with. But, I’m fascinated by the way people think, the way they behave, the way they conduct themselves. And we have this one view, this one article that is just like, “Oh, my God! We wouldn’t think of adjusting somebody who doesn’t have a musculoskeletal problem or doesn’t have a symptom, to this other side that thinks about, “We could change the way the brain works!”
Clum: And the profession’s caught in the middle between these two opposing – apparently opposing – views. I don’t think they are opposing all. I think they’re part of a continuum of thought, but they’re portrayed by some as being oppositional. And so look, if you’re willing to do it with me, let’s take the next few sessions of these. Let’s break these two articles down, do a compare and contrast, and then let’s see if we can really learn a little bit more about the methods, a little bit more about what might be behind what’s going on in the motivation that’s going on with each of these two sets of researchers have brought, to the task in front of them.
Clum: You know, let me also say, I’m sure that they’re all good people. I don’t question that they’re, you know, the good guy, bad guy, good gal, bad gal type stuff. I’m not talking about that at all. I’m just fascinated how you can come up with a structure that is so confining…looking at the data from one perspective, and one that is so liberating looking at it from another perspective. And in doing so, maybe we can learn something from everybody.
Deitch: I think it sounds fascinating. It is a very relevant, timely conversation, to just explore what we tend to see pretty much everywhere consistently these days, which is how do people look at the same set of circumstances, but interpret the meaning of those circumstances in radically different ways. And that’s the challenge with, you know, evidence-based, or science, or so on. I recently completed a book and I’ve got a segment in it that I just call “The Good News About Fake News.” And it is just simply…that doesn’t say that…fake news is good. That’s not what it says. But the upside of this whole in our face, fake news conversation is that there are large groups of people that can look at the same set of circumstances and come to radically different conclusions and that it has become so transparent, as we’ll continue this conversation, to be able to look at the same a person receiving an adjustment coming to radically – or not receiving and adjustment – coming to radically different conclusions, not based on the science, but the interpretation of the agenda they have going into it, and the interpretation of what certain indicators mean or they make them mean, is just fascinating for us to at least start paying attention to so that we can be aware of the…conversation below the surface or agendas below the surface.
Deitch: And hopefully, collectively individually, we’ll learn from them and our own practices will grow individually and collectively as a profession. Maybe both to better understand what’s going on out there, how we can not be as offended by some of the things that are said. I mean, it sounds perfectly legitimate that we should react and be offended by some of those accusations, and some of us might say false accusations, and yet, you know, there’s a game here; this is chess, not checkers. And, hopefully, we’ll be able to explore some of those ideas and strategies, and specifically tactics and action steps, we’ll be able to take in our practices and collectively as a profession in future conversations. What do you say we put the links down below in the comments section, and invite everybody to read through the articles and then invite people to, after they’ve read the articles, join us for our next conversations?
Deitch: We’ll be able to really explore the implications of what the different articles show and what it is that we can learn from them.
Clum: I’m looking forward to it.
Deitch: Thanks everyone, for watching. This has been 33 Minutes. This is going to be an ongoing series of conversations about what’s going on in the world of health science research, chiropractic and beyond, so that we as individual practitioners and collectively as a profession, can really live our potential to be able to help better serve humanity and those people who need it. So thanks for watching. This has been another edition of 33 Minutes. We’ll see you next time.
Dr. Gerard Clum is president emeritus of Life College of Chiropractic West, where he served with distinction for over 30 years. Today, Dr. Clum serves as director of Life University’s Octagon, a think tank dedicated to the development of healthcare policy that honors and supports the innate wisdom of life and healing. In addition, Dr. Clum continues to be involved in protecting and advancing chiropractic on the world stage, through his contributions to the International Chiropractors Association (ICA), the World Federation of Chiropractic (WFC) and the Foundation for Chiropractic Progress (F4CP).
Dr. Jason Deitch is the author of Discover Wellness: How Staying Healthy Can Make You Rich. His entire career has been focused on empowering chiropractors to bring the chiropractic story to the world, through traditional and modern media. Dr. Deitch recently launched Healthy USA 2020 programming in the AmpLIFEied network in partnership with COCSA (Congress of Chiropractic State Associations), sponsored by Standard Process, which provides every chiropractic state association with a social media campaign.
*”33 Minutes”© is a figuratively-titled feature of Today Chiropractic Leadership/TCLonline. The “33” refers more to the 33 Principles described in Stevenson’s classic chiropractic philosophy text and not to the actual length of these features.