Why Chiropractic Needs Abraham Flexner

Some of you already know where I’m going with this.  Half are starting to clap, while the other half is drawing up “Wanted: Dead or Alive” posters.

Others of you don’t yet know who I’m talking about.  That’s okay.  I’ll explain.

To bring everyone up to speed, Abraham Flexner was a researcher and a graduate of Johns Hopkins University who essentially transformed the medical profession from a largely unregulated, inconsistent, scientifically-questionable profession into a standardized, unified, dignified position of cultural authority and positive perception.

Flexner singlehandedly accomplished this feat by publishing a scathing report on the sorry state and disarray of the medical profession circa 1910.  The term “report” is sort of a misnomer, as the work more closely resembled a book.  It tore at the foundation (or lack thereof) of what was American medicine at that time.  The bloodletting, the four humors, the wives’ tales and the witch doctors were all boldly exposed and harshly criticized.  In one fell swoop, he set universal standards for admission, basic and continuing education, licensing, regulation, and a few unwritten agendas such as cultural authority and prestige.

This had several long-lasting ripple effects, all of which continue to this day.  As far as the good of the public is concerned, some of those changes could be perceived as “good”, and others as “bad”.  Among the beneficial changes were a substantial increase in the quality of education and admission, dependable uniformity across the profession, and a closure of proprietary schools (akin to today’s for-profit trade schools that advertise on late-night TV, many of which are expensive and of questionable quality, make dubious claims, and whose credits are unlikely to transfer to other institutions).  As a result of the report, schools either closed altogether or merged with existing legitimate, accredited universities.  This allowed the medical profession to move from more of a quack trade status into more of a respected, coveted profession, by using its alliance with universities to achieve the tall order ideals set forth by the Flexner report while keeping tuition realistic, as well as acquiring an onsite research arm by which scientific advancement could be made and scientific credibility and cultural authority further established.

Some of the less beneficial side-effects that came of this report include the near-abolition of homeopathy and naturopathy as practices and the closing of their schools, somewhat higher healthcare costs (although it has been credibly argued that medical doctors’ salaries do not contribute much to the overall pricetag of our current healthcare system), and a strong bias toward toxic pharmaceutical drugs with an accompanying hostility toward natural remedies and a refusal to accept them as the viable treatment options recent research is increasingly showing them to be.  This narrows peoples’ choices and access to information, and the bias shown is nearly one-sided, which actually goes against the scientific grain, which is supposed to remain objective and in pursuit of truth over profit.

Although the Flexner report has proven to be a double-edged sword in healthcare, it is becoming more and more apparent that the chiropractic profession could benefit substantially from (and many would say is in dire need of) a similar overhaul.  Much like a forest fire, we need to burn down the scrub brush that is currently obliterating our ability to see clearly and start from fresh, new, healthy sprouts, as painful as that process may seem.

In reading about Flexner’s critcism and recommendations, I could not help but to feel as though I were looking instead at the chiropractic profession – the resemblance is that close.  The chiropractic profession has been brewing for quite some time and it is now coming to a head, in much the same manner as the conventional medical profession 100 years ago.

Everything from the unaffiliation between chiropractic schools and established universities to a lack of any kind of standardization in practice or protocol, to the conflicting (or downright lack of) research to explain and justify what we do and why it works, and our eagerness to latch onto the next big thing, the next new technology, fancy toy, pretty lights, or color printouts, all in the name of impressing our patients so we can sell them high-dollar, nearly-indefinite care plans without being able to quote a peer-reviewed study to justify ourselves.  We sorely lack admissions standards; there are no across-the-board entrance testing, interviews, application essays, or required degrees.  We sorely lack relevant board testing – we have board exams, but they’re hardly relevant.  And of course, the periodic motivational seminars or assemblies are borderline-cultish, designed to lift us up from the impending feelings of dread and regret that began to set in for most of us as students.

I don’t want to duplicate the narrowing of the palate of options for the public to choose from or force some legitimate therapeutic modalities to go underground.  I certainly don’t want us to become egotistical gods who can do no wrong and are so sure (full) of ourselves that if we can’t find the cause of a patient’s symptoms, that they must all exist only in his or her head.

However, I do want to close the gap between the extremes of experiences patients relay to us, and boy do they have horror stories about their experiences with other DCs.  Long-term care plans, high-pressure sales, continued use of modalities without results, painful or “wrong” adjustments, uncomfortable vibe, failing to address patient’s questions and concerns about treatment or post-visit symptoms, pushing products, failing to refer or co-treat when appropriate, giving blatantly wrong advice, even taking a picture of the patient against his or her wishes!

Folks, it’s time for this crap to STOP.  If all you’re doing is a Flying 7 on the same segments each time, STOP.  If you’re making wild claims about an expensive toy you like to use and it’s not FDA-approved for that use, STOP (at least stop making the claims).  If you’re brushing off your patients’ concerns because they say they get a headache after you wrench on their neck, STOP.  If they keep complaining of the same thing over and over, STOP doing the same thing you did last time.

Chiropractic is NOT just some easy way to call yourself a doctor and ride around in a BMW looking impressive.  Chiropractic is NOT just a crack here and a crack there.  It’s not just a wave-a-chicken-bone-and-pray-while-you-adjust and hope the problem goes away, either.  “We don’t know why it works, but it works” is not good enough anymore.  It’s time to move beyond that and act like doctors.  Society is changing.  Peoples’ needs are changing.  Your patients’ needs are changing.  It’s time to keep up so we can keep meeting them.

This overhaul is long overdue and truthfully, it’s not that hard.  It comes down to a few things:

1. Research – either do some original case study research yourself or subscribe to some good journals. Dynamic Chiropractic and Chiropractic Economics don’t count – I’m talking about Journal of Manipulative Therapies and Spine here.  There’s nothing inherently wrong with the first two, but they’re trade publications, not genuine research bodies; it’s important to know the difference.

2. Admissions standards – I’ve already posted about these in the rest of my Chiro Cleanup series.

3. Educational standards – also discussed extensively in the rest of my Chiro Cleanup series.

4. Practice standards – far be it from me to tell someone how to practice, and I don’t have an easy, concise solution, but suffice it to say that if you’re simply slamming through a Flying 7 on every patient or you’re dabbling in Multi-Level Marketing (MLM) opportunities or making diagnoses based only on muscle testing (known as Applied Kinesiology, or AK), you’ve got a problem.  I’m also not one of those wet blankets that believes we shouldn’t do something at all until it’s been proven beyond any kind of doubt, but if we’re attempting something theoretical or experimental, let’s be honest with ourselves–and more importantly, our patients–and call it what it is: experimental.

5. Your clinic is not a church – I’d also love to see us get away from the chirovangelical preaching that goes on in too many offices.  Patients usually don’t care, it doesn’t sink in, and they think you’re weird.  Trust me – they do.  I know this because they’ve come out and told us as such, thanking us for not being “freaky” like that.  At any rate, references to God, the Innate, subluxation (especially being sub- “below” -lux- “light”), “above down inside out”, and others, should be kept above your shoulders and between your ears.  Works is work and religion is religion.  Patients don’t want to be preached to or converted.  You’re not a priest, minister, or reverend, your clinic is not a church, and you’re not reciting The Word or the Ten Commandments or anything.  Ya know?  Leave the chiro-theism at home.  Save it for the seminars.

All Hail Flexner.  Now is the time and the time is now.

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