The online Journal
Chiropractic and Osteopathy here reports in a paper on subluxation. The article's abstract states "Subluxation syndrome is a legitimate, potentially testable, theoretical
construct for which there is little experimental evidence. Acceptable
as hypothesis, the widespread assertion of the clinical meaningfulness
of this notion brings ridicule from the scientific and health care
communities and confusion within the chiropractic profession. We
believe that an evidence-orientation among chiropractors requires that
we distinguish between subluxation dogma vs. subluxation as the
potential focus of clinical research. We lament efforts to generate
unity within the profession through consensus statements concerning
subluxation dogma, and believe that cultural authority will continue to
elude us so long as we assert dogma as though it were validated
clinical theory."
The article concludes "Hypothetical constructs involve tentative assertions about physical
reality. They serve as essential tools in the development of science,
and permit the empirical testing of the non-obvious. However, when the
speculative nature of an hypothesis or hypothetical construct is not
made obvious, an otherwise acceptable proposition becomes a dogmatic
claim. Such is the history of subluxation in chiropractic."
"This brief review of the role of subluxation dogma in clinical
practice, in marketing, in the legal and political arenas, as a basis
for professional identity, and in the rhetoric of leading chiropractic
organizations and agencies, is not a statement about subluxation's
validity or lack thereof. Only focused clinical research will enable us
to determine whether the traditional chiropractic lesion merits
clinicians' attention. We don't know whether subluxation is meaningful
or not."
"The dogma of subluxation is perhaps the greatest single barrier to
professional development for chiropractors. It skews the practice of
the art in directions that bring ridicule from the scientific community
and uncertainty among the public. Failure to challenge subluxation
dogma perpetuates a marketing tradition that inevitably prompts charges
of quackery. Subluxation dogma leads to legal and political strategies
that may amount to a house of cards and warp the profession's sense of
self and of mission. Commitment to this dogma undermines the motivation
for scientific investigation of subluxation as hypothesis, and so
perpetuates the cycle."
"The simple expedient of amending dogmatic assertions to note their
tentative, hypothetical character could do much to improve the image of
the profession, to re-orient it to the challenge of testing its
cherished hypotheses and to establishing the cultural authority of
chiropractors in our unique realm of health care. The task of
reorienting the profession to a credible science and art belongs to all
who understand the scourge of dogma, and who seek a brighter future for
the chiropractic profession and its patients."
The lengthy article includes reviews of "The Dogma of Subluxation", "Subluxation Semantics", "Subluxation in Practice", "Subluxation in Marketing", "Subluxation as Legal and Political Strategy", "Subluxation as Identity", "Subluxations as Hypothesis", and "A Simple Alternative".
The last section, "A Simple Alternative" includes the statements "Speculations and tentative assertions are the stuff from which rigorous science emerges...Hypothetical
constructs such as the chiropractic lesion, emotional stress and the
neurotic syndromes may or may not have important implications for human
biology, but it is entirely appropriate to offer such ideas as
tentative assertions. We could, as C.O. Watkins, D.C. urged decades ago, resolve to be
bold in what we hypothesize but cautious and humble in what we claim."
The author encourages "n discussing subluxation, all chiropractors should learn to use
language that denotes the tentative character of many of our beliefs
(hypotheses).... Those who speak for the
profession and who operate in the political, legal and legislative
arenas could advance the cultural authority of the profession by
becoming credible, balanced, evidence-based sources of information
about the chiropractic art. The chiropractic rank-and-file could be
encouraged to recognize that responding to charges of quackery with
unsubstantiated claims for subluxation and for the outcomes of
chiropractic care is self-defeating....Speculations
could be identified as such, so as not to violate the public's trust
and enfeeble the profession's best efforts to progress."
"We ask that those who guide the profession and who understand the
dilemma that subluxation dogma causes the profession, lead by word and
example. Whether one is college faculty or administrator, association
official or appointee to a licensing authority, a willingness to
reframe subluxation as something tentative rather than something
certain is essential."
