Revised editorial (Originally: a call for papers)
Topic: An Inquiry into Chiropractic Theory (and Alternative
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
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.
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
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
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
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
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
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.
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
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
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.
(2). Rosa L, Rosa E, Sarner L, Barrett S.
Close Look at Therapeutic Touch. JAMA.
(3). Palos S. The chinese art of healing Bantam Books;date
(4). Morgan L.
its origins and problems. JCCA 1998;
(5). Gell-Mann M. The
quark and the jaguar. New York: WH Freeman; 1994
The 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
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?