Review & Comment: The Tower of Babel
The Tower of Babel: Communication and Medicine
An Essay on Medical Education and Complementary-Alternative Medicine
Opher Caspi, MD; Iris R. Bell, MD, PhD; David Rychener, PhD; Tracy W. Gaudet, MD; Andrew T. Weil, MD   (INTE ; 160: 21; 27 Nov 2000)

Medline: Caspi O, Bell IR, Rychener D, Gaudet TW, Weil AT. The Tower of Babel: Communication and Medicine: An Essay on Medical Education and Complementary-Alternative Medicine. Arch Intern Med. 2000 Nov 27;160(21):3193-3195. No abstract available. PMID: 11088078

Review & Comment. Virgil Seutter, D.C.

Review: a primary obstacle in the implementation of an integrative medicine may exist for both CAM providers and allopathic physicians; i.e., "the lack of a common language" among both groups. The implementation of educational incentives into the background of CAM providers and the fundamental concepts motivating the CAM provider is not an attempt to understand and "accept" the protocol of CAM providers but to provide the ability to communicate in a common language that might provide the opportunity to further study CAM modalities of care.

For the allopathic physician, it would open the door to more objective evaluation of CAM modalities with less bias by understanding the fundamental concepts in CAM and enabling differentiation of CAM modalities by a knowledgeable understanding of their concepts. Ultimately, the objective would be to create a "new generation of CAM-educated physicians, with the ability to speak the 'CAM language,'" providing "an opportunity to investigate what is actually behind the scenes of these unconventional forms of treatment."

However, the CAM practitioner must also recognize the need to expand the "depth and breadth" of CAM training to encompass an ability to speak the biomedical language. The ability to undertake scientific inquiry into CAM protocol requires an ability to communicate in language that allows examination of conceptual constructs on a level that science can approach.


Commentary

Previous articles have presented discussion of the problem of communication and how language enters into the inability to examine ideas and constructs in thinking . Sometimes the problem of communication can interfere with our ability to objectively examine ideas. The article "Commentary: Holism, Alternative Medicine, and Why Chiropractic Embraces It The inability to differentiate "classical" holism from "contemporary" holism" is an example of how CAM providers confuse the differentiation of classical holism with contemporary holism, preferring to nurture the classical, mystical idea of holism as a defense of their modality rather than defining the characteristics of the concept in contemporary (examinable) terms.

The World Chiropractic Alliance (WCA) International Summit will feature Dr. Karl H. Pribram as a speaker at an upcoming seminar. Part of this conference may involve discussion of "Compartmentalization" as "an over-reliance on the reductive approach." The argument by WCA seems to be that:

[Today there are stirrings, especially in quantum physics and cognitive science that bode well for such a renewal of science in a holistic and wholesome modus operandi." Dr. Pribram once led a conference subtitled "Is the brain too important to be left to biologists to study?" The WCA Summit is a chance for chiropractic to answer his question with a resounding NO! Help us make the case to him that our discipline is the one best suited to clinically apply his living wisdom about brain, body and behavior. His work raises another question. Is subluxation is too important to be left to chiropractors to study?]

The WCA response to the question "Is the brain too important to be left to biologists to study?" is confusing. Somehow, I'm confused in the answer, "a resounding NO!" seems to confuse our language of priorities, seemingly confirming the position that biological sciences are necessary to study the brain... but also that other disciplines might contribute to this study. The question whether chiropractic might be another discipline that could contribute to this study is a problem, at least to my way of thinking, when one considers that the language to explain chiropractic and the brain seems to hinge around the philosophy of innate intelligence in a manner that is not quantifiable. In other words, the language to explain another system of information processing is something chiropractors can't seem to develop in a manner that allows science to inquire into that function, whatever it is.

But how can chiropractic contribute to some enlightenment of this problem, that language might yet define what it is that chiropractors do? How do we "define" innate intelligence? Could it be possible that any definition of innate intelligence is really just another way of saying that we are dealing with an "information system" that is yet indefinable in quantifiable terms? However, if one thinks about it a little longer (gosh, 100 yrs...), one might just be able to see that "information processing" could be a step closer to quantifiable explanation if we consider things like quantum physics, complexity science, etc.

The problem of language in the above context is that the language, and therefore the contextual nature of the question, may not be stated in terms truly understandable. In other words, if science (and, therefore, biology) is finding evidence that "the nerve impulse -- may not be the basic unit of information processing in nervous systems" and that molecular data may "suggest the existence of a literally deeper system," then one needs to question the ability for language to explain this phenomenon. In other words, the ability to examine the nature of holism and "innate" abilities is slightly different (and indefenseable from an innate intelligence argument point of view) if one is not willing to accept the -fact- that a deeper system of communication (or information processing) may be occurring in the body. The latter position opens the door to science and its examination of the process rather than ignoring it as a mystical, non-quantifiable experience.

Biological science has found something else that should be interesting to chiropractors. Noting that Researchers Discover Molecule That Detects Touch" puts another twist into the arguments for explanation of the subluxation as well as the workings of "innate intelligence." In other words, does the challenge to the chiropractic philosophy of a molecular basis for touch imply that the emphasis upon linear mechanisms (subluxation, nerves and their impingements) are outmoded as is the vitalistic philosophy?

If chiropractors are to answer the question "Is subluxation [is, sic] too important to be left to chiropractors to study?" I would somewhat suggest that it is:

[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. Inquiry into Chiropractic Theory: Sorting Myth from Mysticism: Touch as an Illusion]

Somehow, chiropractors cannot accept the fact that the "varying technics" within the profession require explanation that _must_ hinge around the theoretical constructs chiropractors would use to explain their modality. It would be conceivable that if explanations cannot be found to explain these techniques, then it might also be possible that the nature of the subluxation might be too complex to chiropractors and therefore chiropractors (with limited resource for biological research) might be limited in their examination of the "importance of the subluxation." This is further suggested in"

[The question for chiropractic is whether the emphasis on inquiry ought to be placed on a single level subluxation complex or whether a more global view is needed in the inquiry process. The reductionist theory for scientific inquiry has forced the chiropractic profession into a very narrow window for inquiry. The mechano-engineering, structural lesion concept (subluxation) has forced the profession to maintain its focus on the single level lesion (subluxation complex) as contributing to neurophysiologic changes within a wiring system schema. The possibility that a more global approach is needed can only be suggested by viewing not only technique development (3) within the chiropractic profession but the idea contained within Triano's "functional spinal lesion (FSL) (4)." This term expresses "a spine related disorder that involves function" as a dynamic model for inquiry as opposed to the static model of subluxation as structure. Editorial: Vertebral Subluxation Complex and Functional Spinal Lesions; Differentiation and the Search for Mechanisms of Action]

But language must explain something else that CAM providers seem to get confused in their thinking. The varying techniques within chiropractic demonstrate this confusion and the inability to formulate language that truly defines the problem. Developing language is partly a matter of asking the right questions and then trying to answer that question. Much of CAM explanation seems to revolve around the use of, and identification with, a vitalistic phenomenon. This vitalistic phenomenon is usually identified as or with an external, nonquantifiable resource: energy. That most of the application of therapeutic modality is linked to "energy" explanation and then quickly linked to quantum physics and cognitive science as somehow excusable in terms of not being able to find definable explanation, is not acceptable to the science community, nor should it be for chiropractors...

The inability to differentiate and explain technique variables within chiropractic suggests that the chiropractor may not really understand the nature of subluxation and the existence of a possible quantifiable mechanism.

[Chiropractors hardly notice that, in the attempt to condone or condemn a protocol (whether manipulation, muscle testing, or leg length inequality), the chiropractor essentially misses the point; that, in all the ballyhoo about technique, a key observation has been obscured by the focus on the "action" of a protocol rather than the sequence of events that lead to that action. In other words, the ability to study a chiropractic technique may be dependent upon something that actually --- precedes --- the protocol (or the act of differentiation in the protocol). ...That which precedes any observation of change in the act of differentiation (i.e., muscle weakness or leg length change) involves "touch." Commentary: Philosophy/Research: Are chiropractors asking the right questions? How to demonstrate that muscle testing and leg length inequality may be an illusion.]

If chiropractors are to understand the importance of the "subluxation," it will require developing common language that can explain the variables observed within CAM protocol and translate it into objective evaluation by the allopathic community and the inquiring chiropractor...

(chirozine; 3 Dec 2000)

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