Wake Up – We’re in a Race for Scientific Ownership of Manipulation
SOURCE: Dynamic Chiropractic
By William Meeker, DC, MPH, FICC
For several years now, many have pointed out that our major clinical intervention, that family of procedures we call adjustments/manipulation, is no longer a “quack” remedy. That designation changed dramatically over a decade ago with the publication of the RAND appropriateness studies, the AHCPR guidelines on back conditions, and a fair number of randomized clinical trials.
Historically, those studies were very powerful in pulling manipulation out of the closet to where it now is – experiencing a great deal more exposure. As a result, we are seeing a renaissance of interest by osteopathic physicians and physical therapists. This in turn has led to a significant increase in the amount of research on manipulation by these professions. They are challenging chiropractic for pre-eminence in this field.
Professions, by definition, “own” their tools and their knowledge. This means that there is a cultural consensus in society that expertise in the use of professional knowledge is invested in a particular profession because that profession knows the most, is the most expert in, and can do the most good for the public with its unique tools. Lawyers know the most about laws because they make laws, study laws and apply laws. You wouldn’t go to a plumber if you had a legal case. Obviously, the situation is analogous for health care.
A citizen should not have any trouble deciding whom to consult for specific kinds of clinical expertise. But the situation for manipulation is becoming increasingly muddy, if the scientific publication record is any indication. We chiropractors do not enjoy an unassailable cultural consensus anymore when it comes to manipulation and adjustments. Chiropractors certainly have some authority by virtue of our history and training, but others are encroaching. We need to recognize that our authority in this area is under concerted and constant attack, and I fear that we may be losing ground.
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