Author: Virgil Seutter
Date:     October 8, 1997
Parent Node:

7.2  Holism: The Contextual Nature of Manual Methods  (7.2)

7.2.1. The nature of manual methods may be viewed from another perspective, one that uses theoretical model building as a tool for inquiry. Robert D. Mootz examines this model building by defining a Type A versus a Type B theory. Much of this overlaps into definition that has been around awhile but he attributes the perception of "molecular" and "contextual" healing to Dean Black  (7.2.1) as defining a characteristic between traditional and alternative approaches to health care. Black emphasizes the molecular model as a physiological reaction to the bioengineering model in which causal relationships appear as a reducible form to "one cause, one effect" as a root cause to disease. In contrast, the contextual nature of disease may be viewed as a physiological reaction in response to a biopsychosocial encounter. It contains the ingredients of the infomedical model (6.0) previously discussed.

7.2.2. The problem of complexity for Mootz appears to be one of separating the two types of approaches as mere contrasting features. The range of theoretical approaches may vary from micro to macro (global), from simple to complex, molecular to contextual, or in vitro to in vivo, etc. While Type A theories tend to reduce the problem to a smaller component that is subject to technological analysis, the Type B theory tends to be more subjective, possibly relying on "creative inspiration" as the basis for observation of phenomenon. The former would appear more capable of data management by organizing and classifying data. Furthermore, dealing with micro features permits experimentation with relative predictability since single variables can be more rigorously approached as part of a reducible equation. On the other hand, Type B theory tends to be contextual; it captures the gestalt of the phenomenon by observing the pattern relationships which "can neither be derived from the elements of the whole, nor considered simply as the sum of these elements." There would appear to be advantages ...and disadvantages... to both theories.

7.2.3. The "middle ground" approach, for Mootz, would appear as a problem for "fuzzy logic;" that everything is a matter of degree and that "shades of gray" exist in all things complex. The options for inquiry seem limited and yet, the nature of social and economic changes in health care demand accountability. Finding simplicity in nature may be possible, but the social context of medicine has forced innovative changes in experimental design and assessment of clinical outcomes. The emphasis on random clinical trials (7.2.3) places the clinical outcome on "the effectiveness and value to the society as a whole." The accentuation depends less upon biological or theoretical rationale.

7.2.4. The building of theoretical models is dependent upon a discipline's philosophical approach to health care. Emphasis on biochemical and genetic research into disease by medicine has prioritized the research budget toward the Type A model for inquiry. The problem for some disciplines, including chiropractic, is the reliance upon the Type B model that only provides observations and incomplete theories. These theories are inadequate to develop a foundation for research technology. The nature of manual therapy prevents the "perfect blinding and uncontaminated shams" required in a blinded placebo control. On the other hand, some progress in demonstrating clinical successes might be possible using psychopathological models for diagnostic screening. Outcomes, for chiropractic, must be "reasonable, predictable, and reproducible." Increasingly, the trend is toward "evidence based" medicine.

7.2.5. Finding solutions may be dependent upon how chiropractic views its theoretical model. While opportunity exists for more liberal inquiry, the middle ground between Type A and Type B theory may not be sufficient to support research design and investigation of chiropractic. Theoretical model building may require a change in thinking.

Seutter, V. "Commentary: Holism, Alternative Medicine, and Why Chiropractic Embraces It. Holism: The Contextual Nature of Manual Methods" Chiropractic Resource Organization. 8 Oct 1997. ChiroZine ISSN1525-4550
(c) 1997-2001 All rights reserved.

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(c) 1997 Chiropractic Resource Organization. All Rights Reserved. Reprint by permission.

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