Revised editorial (Originally: a call for papers)
Topic: An Inquiry into Chiropractic Theory (and Alternative Medicine)
by Virgil Seutter, D.C.
Preface Recent discussion on one of the chiropractic lists centered around the issue of providing research data in support of chiropractic intervention into health care for conditions other than neuromusculoskeletal. While the issues generated much discussion, the ability to provide research support for chiropractic intervention into general health care remains speculative, at least for those inclined to the scientific bent who demand studies in support of the claims. On the other hand, those who have empirically arrived at some consensus of the benefit of chiropractic intervention remain strong in their belief that something is, indeed, occurring other than placebo.
The recognition that chiropractic remains a novelty discipline for the science community should not be ignored. Much of the research has been directed toward neuromusculoskeletal problems that have, for the most part, found support in a cummulated statistical data-base. On the other hand, the basic premises that would explain chiropractic and its role in general health care have not found support in or through the research effort (1).
The possibility that chiropractic explanations and theory are not keeping pace with contemporary findings in the science community is not without consideration. Chiropractic has not looked beyond its formalized theory of the subluxation complex and innate function to explain itself. Chiropractic literature does not discuss the implications of the theory as a scientific application. It has not discussed the theory as a prelude to further discovery; that finding the mechanism that is idealized in the theory ought to refine the intervention (manipulation) in such a way that more precise methods could be found in the implementation of the protocol. Instead, chiropractic has become proliferated with varying technics all providing a different rationale for its merits.
Content
The Type of Questions Chiropractors need to ask (Questions asked, but never answered)
(Finding science)Sorting Myth from Mysticism: Touch as an Illusion
(Acupuncture)2 Jan 1999
I cannot be certain that further elaboration on theory, rather than philosophy, can be productive. The ability to explain chiropractic in one sitting through an article is not possible. Limitations exist in refereed journals that limit exploration of ideas. The workshop format seems to me to be the better way to explore ideas and venture into different areas of inquiry. The internet media further provides a dynamic format for this inquiry. The idea is not necessarily to provide answers, but to ask better questions.
The call for papers is not confined to chiropractic alone. The need for multidisciplinary contribution is necessary to provide the pedagogical background for effective examination of ideas. Chiropractic has been relegated to that of a participant in alternative medicine. A broader examination of alternative medicine is required to understand those principles involved in chiropractic as well as other disciplines within alternative medicine.
^ The Type of Questions Chiropractors need to ask
This venture will take some weeks to develop. In the meantime, ideas are needed to start a baseline for inquiry. This means articles (urls, whatever can enlighten) by you, the reader. Chiropractic must eventually explain itself within a scientific framework. The following are topics that might stimulate thinking:
Questions asked, but never answered:
What role does Hebbian learning play in chiropractic? How can chiropractic explain the plasticity of the nervous system? How do problems with interexaminer reliability possibly relate to this plasticity of the nervous system and the mechanism of Hebbian learning?
How do we study the topology of the functioning nervous system? Do cutaneous dermatomes reflect a true functional relationship to a functioning nervous system? How can reflex activity manifest through an understanding of topology? How does upper cervical manipulation manifest a reflex influence on dermatome distribution or, on the other hand, how does pinching the big toe produce a subjective response in the sinuses (a grossly stated over-simplification).
How does the subluxation theory fit the gross morphological concept of a pinched nerve when neurons can vary in morphology (number of dendritic branches, sines or input sites, diameter and area of soma, dendrites, dendritic spines and axons); in passive properties (membrane resistivity, input resistance, time constraints, and space constant features). Complicating the picture, how do we account for the number of ion channels in a single neuron that conveys messages? Can the old theory of "pinched nerves" possibly account for aberrancy in neurological behavior?
Is the neuro-mechanistic concept valid?... is the direction of force a critical factor in this conceptual approach to manipulation or are we dealing with something else in which low force technique create equally remarkable change in patient response?
What similarity do leg length checks have with muscle testing? How are the two interrelated? What is the illusion that manifests in both leg length checks and muscle testing?
How do technics develop? What is the rationale for most of the technics, especially those using non-force protocol? Is the difference in technic an illusion or is there a starting point that might explain why and how a technic could develop? Is the technic entrepreneur merely observing a sequential response to a challenge that he has found consistent over a period of time? Is his "theory" a valid explanation or is there some underlying principle that hasn't been recognized?
Can touch be quantified? Can numerical simulation synthesize bifurcations in vector fields?
Or, is there a metabolic optimization occurring that influences information processing strategies? How is it that nutritional substances seem to alter meridian changes and muscle testing responses? Are we really dealing with reaction-diffusion principles as a chemical precursor to morphogenic changes?
How is chiropractic related to the concept of Artificial Intelligence and robotics? How, by modifying neuromusculoskeletal relationships can chiropractic understand itself as dealing with the same questions of function and control as the experimenter in AI or robotics?
How do we answer the riddles: in physics whether Schrodinger's Cat is alive or dead; in chiropractic whether the subluxation is real or imagined?...
Interesting questions, but how chiropractic begins to examine these questions will depend upon ideas by the contributors to this workshop. The articles can range from strict neurophysiological content to Biomechanics, Artificial Intelligence, Robotics, Complexity science, etc.
^ Sorting Myth from Mysticism: Touch as an Illusion
The science community may never understand alternative medicine until it begins to confront the two principle players: chiropractic and acupuncture. The recent decision by the editor of JAMA to publish an article about touch (2) has thrown out the gauntlet. The only rebuttals, from my observations, have been rhetorical. Nothing gained, nothing lost. The question of dignifying research through an experimentalist's experiment loses the point. Even an experiment by a novice can contribute to statistical support of a proposition. It becomes an "outcome," of sorts, that becomes part of the research data base.
The question whether "Therapeutic Touch" is an illusion may be never-ending unless we begin to understand what touch is all about. The idea that we (man - or some object) has the power to heal (ourselves or another) may have some obscure anthropological beginnings that have effectively been lost over a period of time; lost to antiquity somewhere between myth and mysticism ... a relic of our minds ability to play tricks with reality and the true nature of things. It is also the inescapable recognition that much of the observations of the past were perpetuated through myth and mysticism. Science had no beginnings as a formal process of observation until recent centuries. Those observations that created the appearance of real-time events were carried forward through the stories that have become the myths of "old wives."
Perhaps the real story of touch can be found in acupuncture. Science has not been able to sort the myth from the mysticism in alternative medicine. And yet, acupuncture (and its meridian theory) offer some insight into the question of touch and its ability to create the illusion of healing.
Ancient Chinese Medical Philosophy introduces the "doctrine of the five elements." The Book of Scriptures contains "The Great Principle" that has perpetuated acupuncture (3) as a mystical experience (in western, occidental terms, similar principles perpetuate the belief system familiar to us in the form of prayer and healing and touch). But the similarity ends here as eastern and western philosophy become confused with symbolism and myth. The focus for acupuncture appears well-defined as a "meridian" point in contrast to "touch" as a western phenomenon of healing. Focus between east and west has perpetuated itself in metaphorical descriptions hinging on mystical experiences, while plausible experiences, escape detection of the underlying principles that lend support to a scientific inquiry. Both east and west have developed an elaborate system of physical contact to the body (acupuncture and chiropractic) as a method to modulate aberrant behavior within the body.
Based on the premise that physical contact to the body (meridian/needling, etc. versus touch/manipulation) appear to "modulate aberrant behavior" within the body: if we ignore the pitfalls of numerology, one can view the 5 element theory as touch on a global scale; another dimension in which the 5 elements and the 5 seasons, etc. translate into wind and heat and humidity and drought and cold. To simplify, each of these atmospheric influences "touch" the body on a global scale. Each, according to meridian principles, capable of creating chaos within the system. The trick, however (at least from the eastern viewpoint), is to needle the right meridian point to, in effect, modulate that aberrant behavior (i.e., local touch/meridian contact to modulate the effect of global touch reaction).
In principle, it amounts to this: our western minds are capable of focusing on object-orientated causal relationships but fail in the abstraction of eastern concepts. Our focus on touch has been inclined toward object-orientated healing in which extrinsic application takes the form of the "laying-on-of-hands" to crystals, amulets, etc. That each of these may have intrinsic power (electromagnetic, "energy," etc.) isn't the point. The guideline to translating alternative medicine into a scientifically accessible study requires recognition that we may only be "modulating aberrant behavior" as part of an information processing system of neuro-adaptation within the body (in essence, affecting a neuro-communication system).
Both chiropractic and acupuncture have been dealing with the same principle: neuro-communication. The science community may not be able to understand alternative medicine until it recognizes that both chiropractic and acupuncture are dealing with the same phenomenon but on a different dimension. In other words, in much the same way we view the differences between particle theory and wave theory in physics, on a biological level chiropractic has been dealing with a physical system of neurophysiological concepts based upon reductionist, linear approaches. Focusing on the neuroanatomical, visible spine, the effort to find evidence for a reducto-mechanistic theory has failed to be rewarding as a linear approach to somato-visceral responses. And yet, tenaciously, chiropractic recognizes a neuro-communication principle by adhering to an innate philosophy.
In contrast, the acupuncturist has been approaching the problem from the periphery and working in. His efforts begin at the peripheral nervous system through imaginary spatial patterns on the surface topography of the body. It's a non-linear pathway, disparate to anatomical and neurophysiologic markers. The ultimate objective is similar to chiropractic: the ability to effectively modulate a somato-visceral response. The acupuncturists claim to be influencing the information processing system of the body is subdued but implied, using metaphors to envision a neuro-communication pathway.
The possibility that chiropractic may be dealing with two separate systems (neuro-physiological, the other neuro-cognitive) cannot be ignored from a scientific perspective. The ability to find "logical consistency or conceptual coherence (4)" to any theory of chiropractic is dependent upon resolution of the presumptions within the theoretical framework and finding tools by which to examine those presumptions. Chiropractic subluxation theory, as stands, does not include the neurocognitive component as a scientific statement of plausibility; rather relying on "innate intelligence" as a metaphysical description. The underlying problem within chiropractic is how do we translate metaphysics into a scientific context of relationships?
The recognition that both acupuncture and chiropractic may be dealing with a neurocognitive component still leaves questions about how to pursue inquiry. Further recognition that acupuncture relies upon topographical spatial patterns as a starting point in the ability to intervene in body responses only provides for speculative inquiry ... and experimentation. The type of experimentation that might be best suited to this inquiry may depend upon how we utilize the scientific methods already available.
Examination of complex adaptative systems requires tools by which to identify regularities in the data streams the body receives (5). The possibility that complexity science could provide clues to undertake examination of "neurocognitive" function within the body depends upon the ability to use topographical analysis of the body surface. In principle, a coarse graining analysis of the body surface might be possible in providing fitness landscapes to identify underlying mechanisms. In other words, while the neuroscience community is busy mapping the brain to detect pattern changes in consciousness, chiropractic may need to consider mapping the body surface in the same way and using probability analysis to detect pattern changes (in essence, mapping body consciousness).
The unresolved question of "therapeutic touch" is not one to be ignored by those who use physical contact methods to intervene in health care. The ability to open any scientific dialogue into therapeutic touch depends upon how we ask the proper questions. Outcomes, alone, are not sufficient to enlighten the science community that touch may, indeed, be a real phenomenon and a viable resource in the health care armamentarium; the use of massage, as an example, to reinforce the bonding between mother and infant recognizes the psychological mechanism of imprinting and the benefits derived from the methods. It fails, however, to provide the understanding of the more intrinsic, operative mechanisms that allow it to work in the first place. In the same manner that chiropractors can say that "chiropractic works" because the outcomes point to the favorable results does not provide the scientific explanations necessary to satisfy the requirements for scientific inquiry.
^ More on Outcomes and Research
Outcomes in research is part of the ability to demonstrate the effectiveness of a particular application. It implies a certain correctness in the application, that the underlying principles that nurture the use of that application are basically appropriate, and that an outcome result supports the application as acceptable within the abilities of science to provide some form of proving to a procedure. In essence, it is dependent upon the "belief" that an application can be supported as a measurable outcome and, therefore, is appropriate for application as viable procedure.
Outcomes, however, may have some limitations. A significant limitation can be recognized in that outcomes seldom provide any insight into the underlying mechanisms that make the application work (often the theory is already in place to nurture the experiment in the first place). An outcome is simply an experiment. The results are the end-product of that experiment either verifying or disqualifying the procedure.
A more important limitation may exist in the underlying theory that nurtures the experiment. A theory is merely an intellectual tool by which to explain a phenomenon. Either it is complete, incomplete, or false. If the experiment fails to provide favorable outcome it's significance can only be interpreted as a false theory. More often, however, theories are advanced with the idea that research (experimentation) can round-out the theory and provide more complete insight into the theory at a later date. It means, in effect, that experimentation has capability of providing favorable outcomes ... even though the theory may be incomplete. (note)
This latter experimentation, the search for favorable outcomes, has created a predicament for not only the chiropractic researcher, but the clinician and the chiropractic philosopher.
Given the theory of the spinal subluxation by chiropractic's founder (and it's development into a complex later), the researcher has found difficulty in verifying a somato-visceral effect that can be attributed to the subluxation. In turn, the clinician is left with mixed signals; not able to find scientific verification for his application he has been forced to choose either between science (and the role of manipulation in musculo-skeletal application ... maintaining his stoicism in the faith that something may eventually emerge to confirm his belief) or that of philosophy and a non - quantifiable "innate" function. The chiropractic philosopher is content to accept innate as the "something - else - going - on" notion without question since reaffirmation of his protocol occurs daily through the positive feedback of a satisfied patient, not needing to worry about the science. Unfortunately, this latter position is not sufficient to bootstrap the profession into the next century as a scientifically based health care discipline.
^ The Goal of Workshopping and a Time to Experiment
The goal in workshopping chiropractic theory is not to prove or disprove a particular idea but to examine those ideas in a manner that might shed new insight into the problem of finding definition for chiropractic. It is also possible that those who use physical contact methods to intervene in health care are susceptible to the errors of illusion. Science is embarking on a new century of exploration. The last century has experienced a knowledge explosion that has no parallel in the previous experience of mankind. And yet, "therapeutic touch" remains a mystery to the science community. It remains a mystical experience that, somehow, has not been considered as part of a serious scientific inquiry.
For a profession that uses physical contact methods to intervene in health care, it would seem plausible that therapeutic touch be examined as a priority. This is especially timely since chiropractic encompasses a number of technics and protocols that use touch as a basis for access to therapeutic intervention. Attaching significance to manipulative protocol may not be understood until chiropractic understands why touch plays such a dominant role in its protocols.
Experimentation is not simply a matter of finding tools for inquiry into its protocols, but experimentation with ideas, as well.
(1). Nansel D, Szlazak M. Somatic dysfunction and the phenomenon of visceral disease simulation: a probable explanation for the apparent effectiveness of somatic therapy in patients presumed to be suffering from true visceral disease. J Manipulative Physiol Ther. 1995;18;379-97.
(2). Rosa L, Rosa E, Sarner L, Barrett S. A Close Look at Therapeutic Touch. JAMA. 1998;279:13;joc71352
(3). Palos S. The chinese art of healing Bantam Books;date unknown
(4). Morgan L. Innate intelligence: its origins and problems. JCCA 1998; 42(1):35-41
(5). Gell-Mann M. The quark and the jaguar. New York: WH Freeman; 1994The implications of this statement might be confusing. It could imply that an unfavorable outcome should suggest that the theory is false. It would imply, as an example, that the experiment performed for touch in JAMA proves at the very least a questionable basis for the theory of touch. My point is that outcomes, while helpful in evaluating applications, are limited in searching for the underlying mechanisms that support the contextual nature of the theory. While the experiment adds to the data base, it still leaves questions about the theory and a more complete statement would qualify by stating that any outcome, either favorable or unfavorable, may not necessarily reflect the true nature of the underlying theory as complete.
Whether it's an argument about touch or that of innate, the skeptic must evaluate the contextual nature of the argument. Acceptance of the validity of touch, or that of innate, is based upon a generalization of the theory. The arguments will always be perpetual, never-ending, and in the end frustrating because neither viewpoint can win. Nor is it science.
But should we be cautious about science? Perhaps, if one relies upon outcomes alone. An example is the conflicting findings in research studies that are becoming more obvious in our daily tabloids. This is especially apparent in conflicting studies dealing with nutrition and the pharmaceutical industry.
Do we have illusion in science? Perhaps, if we consider that experimentation could be incomplete or that we ignore common sense. Whether we talk about touch, innate, or simple things, like vision, we are essentially trapped in illusion. Carried further, it becomes a delusion. What we see may not always reflect the true nature of things. There is illusion in science. One example is the existence of a blind spot in our visual field (Blind Spots: Seeing more than your eye does). We know that the brain has a lot to do with how we manage to ignore this blind spot. If science had stopped at the blind spot, perhaps we could all agree that we are dealing with illusion and that nothing really makes sense. On the other hand, science moved on (no doubt a belief that something else was going on) to find the correlations that manifest in the brain. We found that our sensory system is more complex than we imagined. What about touch? What about innate? Is there more to all this than our generalizations would imply?
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