March 2007

Subluxations ‑‑ so what?

by Dr. Matthew McCoy

For more than 100 years, chiropractors have been proclaiming the negative effects of vertebral subluxation as well as the positive benefits of subluxation reduction and correction. During those hundred years, chiropractors were labeled as cultists for even suggesting that such an entity existed let alone that its existence had deleterious effects on health.

Even some within the profession (including some considered "leaders") questioned the existence of vertebral subluxations and periodically there are calls to do away with the term as too ambiguous, politically charged or just simply unproven.

James Winterstein, DC, for instance, stated that "We must differentiate ourselves from the Straights," by dropping the term subluxation and using the term "Functional Articular Lesion."

("Chiropractic Medicine for Tomorrow," presentation at New York Chiropractic College, 2/10/2005.). Dr. Winterstein, as you may recall, is president of the National University of Health Sciences (which used to be called National College of Chiropractic) and serves on the editorial board of the Journal of Chiropractic Medicine.

Most leadership within the profession has taken a softer stance on attacking the term over the past several years, especially following the signing of the ACC (Association of Chiropractic Colleges) Paradigm Statement where the presidents of all North American chiropractic programs actually agreed upon a definition of subluxation.

While it might seem the subluxation has once again been saved from extinction within our vernacular, the reality is that we are at more of a crossroads than ever. The fact is that what has been generally accepted is more of an orthopedic definition of subluxation ‑‑ certainly one divorced from the early model of subluxation, which included interference to the mental impulse as a necessary component. (see: "A Proposed Vertebral Subluxation Model Reflecting Traditional Concepts and Recent Advances in Health and Science" by William R. Boone PhD, DC and Graham J. Dobson, DC, Journal of Vertebral Subluxation Research, August 1996, www.jvsr.com/abstracts/index.asp?id=49 )

In fact, the neurological component is still unacknowledged by many, such as Drs. Reed Phillips and Robert Mootz, who noted "The chiropractic perspective on health and disease emphasizes two fundamental characteristics: (1) a testable principle suggesting that the structure and condition of the body influences how the body functions and heals and (2) an untestable metaphor that asserts that the mind‑body relationship is instrumental in maintaining health and in healing processes." ("Chiropractic in the US: Training, Practice & Research," AHCPR)

The powers that be within and outside the profession have in essence stated: "Okay, we'll give you that subluxations in one form or another actually exist ‑‑ but so what?"

That leads to a barrage of other questions, including:

***  If subluxations exist, what evidence do you have that they have any clinical meaningfulness?

***  If subluxations exist, what evidence do you have that their existence leads to adverse health outcomes?

***  If subluxations exist and you have some evidence that their existence leads to adverse health outcomes, what evidence do you have that you can correct subluxations?

***  And if you have evidence that you can correct them, what evidence do you have that correcting them leads to improved health outcomes?

Given the increased importance of evidenced‑based health care, we can no longer make unfounded claims about vertebral subluxation and their alleged adverse effects or that we have the ability to correct them and, in doing so, bring about positive health outcomes.

Look at the CCGPP Best Practices (dubbed by many as "Mercy II" for obvious reasons) and you'll see what's coming our way.

Those of us who hold with the traditional view that chiropractic's purpose is to correct vertebral subluxations because those subluxations can negatively impact health, are being painted as unscientific religious zealots and even frauds. As George Goodman, DC, president of Logan College wrote in reference to the subluxation‑centered fraternity, Delta Sigma Chi: "They represent the anti‑educational, non‑diagnostic and a transitory obsessive devotion to a narrow view of chiropractic. This group representation would be similar to a pro‑abortion organization at St. Louis University or at its medical school."

He's not alone in his disdain for subluxation‑based chiropractors. Reed Phillips, DC, stated: "If the formation of chiropractic groups opposed to improving educational standards, advancing our scientific research accomplishments, discoursing intellectually with our colleagues in the various health professions, or accepting responsibility for patient care beyond what some may consider to be, are not myths, then at least the unscientifically validated constructs (i.e., the subluxation) would represent, by Armstrong's description, a chiropractic counterculture to the profession's scientific and academic advancements." ("The Battle for Innate: A Perspective on Fundamentalism in Chiropractic," The Journal of Chiropractic Humanities, 2004).

In short, according to him, the subluxation is merely an "unscientifically validated construct."

To address this kind of criticism effectively, we have to be honest with ourselves and with each other. The rank and file and even some of the leaders in the subluxation‑centered community have acquiesced to the cartel within chiropractic that seeks to remake us in a more "modern" image ‑‑ an image that deliberately excludes the vertebral subluxation.

Hopefully, the subluxation‑centered community will remember that it has a rich history and respect for science, research and evidence and this recollection will hopefully motivate it to do a few things immediately:

1. Support subluxation‑centered research. This can be done by subscribing to and supporting those research journals that are subluxation‑centered and by donating money to subluxation‑centered research organizations like the Council on Chiropractic Practice.

2. Support subluxation‑centered educational institutions.

3. Get involved politically at the state and national level.

4. Stop supporting those groups, schools, organizations and individuals who seek to destroy you.

If you don't think your vigilance and support are needed, just read what Louis Sportelli, DC, former president of the American Chiropractic Association, had to say about you: "The need to be validated is what continues to be the key to why these 'cult' groups continue to exist and flourish. They have a cause and the cause is so powerful that to deny the basis of the cause is more than many could handle. Many in the profession, who do not openly adhere to the open 'mythos,' still feel some kindred spirit to this thinking. Many...had the strength of the philosophy to fall back on ALWAYS...if the patient did not get better it was 'limitation of matter,' if they did, it was 'the wonders of chiropractic.' If we did not know what was wrong with the patient, what relevance was it, 'find the subluxation and the body will heal itself'..." ("The Battle for Innate: A Perspective on Fundamentalism in Chiropractic," Journal of Chiropractic Humanities, 2004).

You're a member of a cult. You're a fringe group. You're old fashioned and outmoded. You need to be shoved aside so the chiropractic profession can be cleansed of you. Chiropractic has nothing to do with subluxations.

If you don't stand up and fight back, that's going to be chiropractic's epitaph.

(Dr. Matthew McCoy is one of the founding members of the Council on Chiropractic Practice and has been instrumental in the development of the profession's most widely accepted set of chiropractic guidelines. He's also editor of the Journal of Vertebral Subluxation Research and has extensive practice, research and educational experience. He gained international acclaim when he helped introduce chiropractic to the Russian medical community by developing a chiropractic spine treatment, teaching & research center in Vladivostok, Russia. He is currently the Director of Research at Life University. Dr. McCoy is Vice‑President of RCS, serves as a member of the WCA Board of Directors, chairs the WCA Chiropractic Advocacy Council and was a liaison member of the National Academy of Sciences and Institute of Medicine's Committee on Alternative Medicine. He can be contacted via e‑mail at editor@jvsr.com)