My First Paper from Chiropractic School

University of Western States
in

I recently found myself digging through the hard drive where I’ve saved all of my documents from chiropractic school–notes, syllabuses,1 and, in some cases, final papers. It was fun–enlightening, even–to read my thoughts from years ago, when I had just embarked on the journey to become a chiropractor.

I thought it would be fun to post here,2 if only as an exercise in sharing my writing more.

This was the final paper from Principles & Philosophy of Chiropractic taught by Dr. McCaffrey. Unfortunately, I don’t seem to have the prompts anymore3, so it’s not totally clear what I’m answering. But, the thoughts are interesting to read regardless.

Principles I Final Paper

Winter 2013


  1. The focus on Evidence Based Practice (EBP) at UWS was one of the primary reasons I chose to attend this school. While the placebo effect can be a powerful treatment, doctors (including chiropractors and any other health professional) have an ethical obligation to use the most effective treatment methods known. That said, using only treatments which have been evaluated and determined to be effective can greatly limit the scope of practice. There are two important things to keep in mind. First, stay current on recent research. Knowing how to evaluate research papers for validity and application to various patients will allow a doctor to confidently provide the best treatment. Second, help patients stay informed and allow them to make their own treatment decisions. As long as patients understand that a treatment has not been confirmed to be effective, it is alright to treat them with informed consent.4
  2. The history of eastern medicine is rich and fascinating. It is interesting to note what ideas have proven to be consistent with science and to further note the extent to which the original traditions are still followed despite being disproved. Similarly, chiropractic seems to be undergoing a scientific re-evaluation, with many doctors unwilling to accept the recent evidence that challenges the traditions of the vertebral subluxation. While the old explanations of how yoga, acupuncture, meditation, herbal medicine, and spinal manipulations are beneficial may turn out to be incorrect, it is important to recognize that they are nevertheless effective in certain cases and at the very least are enjoyable for patients.5
  3. It is surprising to me how prevalent bone manipulation has been throughout history. It seems that embracing the wide and varied history could possibly present a path of development much more analogous to that of medicine with its blood letting and purging. Nearly all cultures have a tradition of bone moving as a therapy for pain and illness. It sure would be great if people accepted bone moving as a common treatment that’s been around for hundreds of years instead of just since 1895.6
  4. Understanding the history of manipulation and it’s use in other professions such as osteopathy only makes it that much more dumbfounding to me why many chiropractors continue to defend the “origins” of chiropractic as coming from D.D. and B.J. Palmer despite the controversy and lack of support for many of their claims. Wouldn’t it be beneficial to the profession to expand its history past the dogmatic regime of the Palmers? Shouldn’t we let go of the 33 Principles which contribute very little to the understanding of the body and the benefits of chiropractic?
  5. Chiropractic philosophy was what first interested me in the profession, but it has since been the cause of much doubt and frustration. The various philosophies within chiropractic are inconsistent and difficult to define. Apparently, the Palmer’s definition was to correct spinal subluxations by manipulation and thereby reduce interference to nerve function. More currently, chiropractic appears to be the treatment of biomechanic restrictions, malpositions, and/or subluxations (depending on the definition of subluxation). Such adjustments may or may not affect nerve function, but serve to reduce pain caused by those issues.
  6. Chiropractic has long been the subject of criticism from those in the medical profession, as evidenced by the AMA initiative which led to the Wilk’s trial. This is likely due to a variety of issues, not the least of which is the language used by chiropractors. The phrases used to describe the principles of chiropractic–such as life force, innate intelligence, and especially vitalism–do not resonate with academics and medical professionals. To cooperatively treat patients that can benefit from a variety of approaches, chiropractors ought to approximate their terminology to the other medical professions.
  7. In all fields of study based in science, academic literature is the standard by which new ideas are shared, evaluated, and confirmed. Chiropractic still has roots based in philosophy which, fundamentally, is not testable. As chiropractors make health claims that challenge scientific understanding, it is important to test those claims and compare them to more traditional medical treatments. Scientific experimentation is the only way to systematically test and confirm or disprove their efficacy.
  8. I am pleased and impressed with the involvement of UWS in the chiropractic profession. From President Budden who made great strides in improving the education standards for chiropractic, to the recent federal grant for research, I feel that UWS is helping the profession move into a direction of more scientific validity and respect.
  9. Dr. Brimhall has a great breadth of experience and interesting opinions on the state of the chiropractic profession. One of his main points was that the mechanisms of how treatments work is not important as long as the patient is getting better. In his experience, patients don’t care about the details of why chiropractic works, just whether it will help them to be free of pain. He also likes to use a variety of analogies to explain concepts to patients.7
  10. Dr. Lamm’s presentation was my favorite of the semester. He addressed many of the concerns and curiosities I’ve had about a future practice, namely the possibility of practicing internationally.8 I was appreciative of all the work he put into determining the details of the scope of practice in all 50 states and select countries.9 I also appreciated his emphasis of the importance of research - to find truth, which he describes as mutually verifiable information.10
  11. I appreciated hearing from a panel of practicing doctors who have different perspectives and experiences to share. Dr. Chris Olshove emphasized the importance of trying new things throughout your career. She herself started multiple practices with different focuses and built them up to thriving businesses. All of the panelists agreed that it is crucial to continue reading and learning even after – or perhaps especially after – graduation. Dr. Panzar and Pehram frequently mentioned that they rely on their clinical experience a great deal, possibly more than they rely on research. I was intrigued by Dr. Pehram’s integrated practice incorporating all branches of medicine and complementary therapies.

Let me know, would it be worth sharing more of my papers from chiropractic school?

Footnotes

  1. apparently, syllabuses is valid. Though I prefer syllabi, it can sound pretentious. ↩︎

  2. with some commentary in the footnotes. ↩︎

  3. they may actually be in the hard copy notes, which I probably threw out recently. If I find them, I’ll update this post ↩︎

  4. I don’t think I had been introduced to Paul Ingraham’s PainScience.com by this point. But my thoughts at the time certainly fit in with his stance on Science vs. Experience in Musculoskeletal Medicine. As he says:

    Professionals can legitimately do a lot sketchy stuff if only they speak the magic words: “This is experimental. It may not work. I think it’s worth trying because yada yada yada and the risks are super low. Do you want to proceed?” ↩︎

  5. While the enjoyment aspect is still valid, I find it to be a horribly insufficient reason for someone to spend 3 years and $200,000+ on an education to provide spa treatment–if that’s all it was. ↩︎

  6. This interview with Anthony Nicholson on the Chiropractic Forward podcast was an excellent discussion on the history of manipulation. ↩︎

  7. Looking back, I disagree with a lot of the opinions expressed by Dr. Brimhall. I’m sure I was, at least in part, deferring to his authority, let alone his physical stature. Now, however, I would be more willing to respectfully disagree. ↩︎

  8. Ha! I still remember him telling us that he accepted chickens as payment while practicing in the mountains of Nepal. Is it any wonder I continue to work with World Spine Care today? ↩︎

  9. Updated version here: Chang, M. (2014). The chiropractic scope of practice in the United States: a cross-sectional survey. Journal of Manipulative and Physiological Therapeutics, 37(6), 363–376. ↩︎

  10. Though, he vehemently disagreed with me that science does not prove anything. Ah, well, no one is perfect. ↩︎