Chiropractors grow weary of reading articles that discuss what chiropractic is and does but never offer chiropractors themselves a chance to get a word in edgewise. Inevitably, the journalist allows the chiropractor to be spoken for. Yet I find it disappointing to read the ease with which medical doctors speak of a topic beyond their depth. In York County, Pennsylvania, Judge Joseph E. Erb recently ruled in an insurance case that "a medical doctor is not professionally capable of giving an expert opinion concerning the chiropractic profession." Is it so difficult to fathom how limitations exist in the training of an MD?
The root of the problem lies in the chiropratic-medical debate and with an American health care consumer who identifies closely with medicine -- sometimes too closely for his or her own good. To comprehend the debate, one must understand the nature of the two arguments and the comparative parallels each has made through the 20th century.
The medical view on health versus disease is rather broad-spectrum and difficult to pin down. Briefly stated, it is that disease arises from exogenous (outside) factors such as viruses and bacteria that attack the human body, which is considered a stationary target. The assumption that the body is relatively defenseless gives rise to the perennial medical strategy against disease -- to medicate, operate and otherwise heroically intervene on behalf of the undynamic human host.
Unfortunately, prevention plays a very limited role in this strategy, the most eloquent illustration of this being the priorities of major health care reimbursement plans, which are geared almost exclusively toward disease care.
The chiropractic viewpoint is different in one or two ways, which make it a virtual opposite and put it more in line than orthodox medicine with the emerging ideas in biomedical research about the importance of preventive medicine.
This is ironic considering that the chiropractic model remains all but semantically the same since 1895, when chiropractic was discovered. Essentially, the differences are that disease is the product more of endogenous (inside) factors, though exogenous ones are important still, and it is the genetic constitution, habits and life style of the individual that mainly determine endogenous resistance.
Furthermore, a healthy, functioning nerve system (brain, spinal cord, sympathetic, parasympathetic and peripheral extensions, etc.) is paramount in the maintenance of resistance, and the spine and its immediate anatomical partners are, to date, our best means of evaluating and correcting this relationship.
Place these two perspectives in the context of the prevalent socio-medical views of 1895. Little of the nerve system was understood or thought important for medical treatment, but medicine, despite sketchy rationales, palliatives and procedures that drove 40 percent of a dubious public into the offices of homeopathic doctors rather than allopathic, nonetheless was a revered and influential profession.
Over the next 30 years organized medicine took its first and final look at chiropractic, doing itself and the public a disservice by trying to make sense of the chiropractic rationale by fitting it into the medical.
After the 1913 Flexner report, which set the standards of education and training for American doctors, the face of modern medicine began to change. It took on the hard, handsome image of the profession now ubiquitous worldwide, which is now the standard, at least esthetically, by which all others are measured. But while the Flexner study established the foundation on which the "clean-up" of medical respectability was instituted, and although it inaugurated the "officialness" of the profession, the esthetic improvements did nothing to expand the premises on which medical practice was based, nor did it lessen the heroic nature and the invasiveness of modern medical therapeutics.
So as medical elitism, the interweaving of medicine with government at the federal and state level, and disease care technology increased, the movements imploring a closer look at endogenous resistance were regarded as fringe elements or outright quackery.
Only now is the trend beginning to shift directions as medicine responds to the changing demands of a more enlightened consumer, a consumer aware of the great body of research from the Unites States, Japan and Europe indicating that we can "fortify" ourselves by eating the correct foodstuffs, exercising, managing stress more proficiently, and decreasing our exposure to sensitizing materials causing progressive metabolic disorders such as cancer, diabetes, arteriosclerosis and arthritis.
Indeed, what waits for us on the horizon is a cohesive, exciting concept giving much more credence to the importance of homeostatic resistance, and to prevention rather than intervention, which at once fails to address the complex network of internal causes, or the relative safety of such measures in comparison to more conservative treatment programs.
In conclusion, the conflict between doctor of chiropractic (DC) and medical doctor (MD) has little to do with science or research, public interest or public safety, or any other principles more philanthropic than the politics of health care dollars and third-party reimbursement. The struggle for chiropractors has always been one of educating the public and media, in spite of medicine's considerable influence with every outlet for federal research funding and every agency responsible for the formation of public health care policy.