Review & Comment: The Tower of
The Tower of Babel: Communication and
An Essay on Medical Education and
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:
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.
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
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)
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.
into Chiropractic Theory: Sorting Myth from Mysticism: Touch as an
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
Editorial: Vertebral Subluxation Complex and Functional
Spinal Lesions; Differentiation and the Search for Mechanisms of
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
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)