The purposes of this study were to develop a pain management model using traditional medicine (TM) vodou healing methods; to survey a sample of French dentists to rate components of conventional and proposed TM vodou-based pain management model; and to assess the possibility of conventional, allopathic providers to integrate TM or complementary and alternative medicine concepts.
From a set of 30 fact sheets collected from TM African healers (vodou healers), main clinical concepts and terminology were extracted. Twenty vodou-based pain management concepts were collected from an interview with a TM vodou practitioner. From this information, a 7-step vodou-based pain management model was created. A sample of 40 French dentists from Nantes, France, whose practices focused on the clinical treatment of dental pain, was surveyed to assess the importance of both TM (vodou) and conventional biomedical components.
Seventy percent of the dentists sampled rated the rational components of the TM model as “very important” or “important” for pain treatment, whereas 2 other traditional concepts were considered to be “supernatural” or beyond understanding.
This study showed that traditional healers used conventional concepts and conventional practitioners could use traditional concepts. This suggests that conventional allopathic medical providers have the capacity to integrate biomedical concepts and other therapeutic and explanatory models. This information may be helpful to understand and improve risk management by anticipating and preventing potential reasons for failure in TM integration strategies and to enhance communication between patients, healers, and physicians to optimize TM or complementary and alternative medicine integration.
Traditional medicine; Complementary therapies; Integrative medicine; Pain management; Cultural characteristic; Communication; Dentists; Medicine, African traditional
The purpose of this article is to provide expert viewpoints on the topic of diversity in the chiropractic profession, including cultural competency, diversity in the profession, educational and clinical practice strategies for addressing diversity, and workforce issues. Over the next decades, changing demographics in North America will alter how the chiropractic profession functions on many levels. As the population increases in diversity, we will need to prepare our workforce to meet the needs of future patients and society.
Chiropractic; Cultural competency; Cultural diversity; Education; Minority health; Health occupations
The purpose of this study was to track the graduates of the Los Angeles College of Chiropractic (LACC) radiology residency program, review their scholarly productivity, and report those involved in teaching and leadership positions.
Former LACC residents’ career information was identified through publicly available electronic documents including Web sites and social media. PubMed and the Index to Chiropractic Literature databases were searched for chiropractic graduate job surveys, and proportional comparisons were made between the career paths of LACC radiology residency graduates and those of non–residency-trained chiropractors.
Of 47 former LACC residents, 28 (60%) have or previously had careers in tertiary (chiropractic) education; and 12 (26%) have attained a department chair position or higher at tertiary teaching institutions. Twenty-two (47%) have or previously had private radiology practices, whereas 11 (23%) have or previously had clinical chiropractic practices. Often, residency graduates hold or have held 2 of these positions at once; and one, all 3. Chapters or books were authored by 13 (28%).
Radiology residency LACC graduates are professionally active, particularly in education, and demonstrate scholarly productivity.
Chiropractic; Radiology; Diagnostic imaging; Residency; Education
The chiropractic profession has struggled with how it is viewed and perceived by those within the profession and the powerful forces outside the profession. This commentary suggests that the vast majority of professional unrest is largely due to lines drawn upon philosophical boundaries and how we perceive what we know. For the profession to advance, it is imperative that unsubstantiated claims are eliminated from our justification for being and that we continue to test theories using scientific methods. Theories espoused must be able to be supported by valid research, and we must be ready to accept the results of these investigations and either build upon that body of research or accept the findings and move in alternative directions that science will take us. In doing so, we will contribute to the philosophy of health and perhaps help to change the health care paradigm from disease focused to wellness, which is based upon evidence and not emotion.
Chiropractic; History; Philosophy; Humanities: knowledge
This commentary considers one of the articles published in the first volume of this journal and reflects on the status of research and knowledge at that time. The chiropractic profession has witnessed advancement in the use of the scientific method in the past several decades, and scholarly journals have helped support this substantial growth.
Chiropractic; History; Philosophy; Humanities; Knowledge
This classic article was published in the first volume and issue of Philosophical Constructs for the Chiropractic Profession. In this paper, Dr. McAndrews reviews the use of the term “philosophy” in chiropractic and urges the chiropractic profession to consider the use and misuse of this term. Reprinted with permission from McAndrews JF. The Knowledge of Our Knowledge. Philosophical Constructs for the Chiropractic Profession. 1991;1:14-17.
Chiropractic; Philosophy; History
The term subluxation has come to have different meanings for different health care professions in the United States for over the past century. This controversy has resulted in some contention both internal and external to the chiropractic profession. Some current factions within the chiropractic profession hold the term subluxation to be synonymous with the identity of chiropractic itself; however, this term was not solely used by chiropractic during its formative years. The purpose of this article is to look at uses of the term by various professions (osteopathy, medicine, and chiropractic) at the turn of the century, a time in which the chiropractic profession was developing.
Subluxation; Chiropractic profession; Osteopathy
The purpose of this article is to discuss a theoretical basis for wellness chiropractic manipulative care and to develop a hypothesis for further investigation.
A search of PubMed and of the Manual, Alternative, and Natural Therapy Index System was performed with a combination of key words: chiropractic, maintenance and wellness care, maintenance manipulative care, preventive spinal manipulation, hypomobility, immobility, adhesions, joint degeneration, and neuronal degeneration. Articles were collected, and trends were identified.
The search revealed surveys of doctors and patients, an initial clinical pilot study, randomized control trials, and laboratory studies that provided correlative information to provide a framework for development of a hypothesis for the basis of maintenance spinal manipulative therapy. Maintenance care optimizes the levels of function and provides a process of achieving the best possible health. It is proposed that this may be accomplished by including chiropractic manipulative therapy in addition to exercise therapy, diet and nutritional counseling, and lifestyle coaching.
It is hypothesized that because spinal manipulative therapy brings a joint to the end of the paraphysiological joint space to encourage normal range of motion, routine manipulation of asymptomatic patients may retard the progression of joint degeneration, neuronal changes, changes in muscular strength, and recruitment patterns, which may result in improved function, decreased episodes of injuries, and improved sense of well-being.
Physician practice patterns; Secondary prevention; Tertiary prevention; Chiropractic; Manipulation
The purpose of this article is to present select concepts and theories of bureaucratic structures and functions so that chiropractic physicians and other health care professionals can use them in their respective practices. The society-culture-personality model can be applied as an organizational instrument for assisting chiropractors in the diagnosis and treatment of their patients irrespective of locality.
Society-culture-personality and social meaningful interaction are examined in relationship to the structural and functional aspects of bureaucracy within the health care institution of a society. Implicit in the examination of the health care bureaucratic structures and functions of a society is the focus that chiropractic physicians and chiropractic students learn how to integrate, synthesize, and actualize values and virtues such as empathy, integrity, excellence, diversity, compassion, caring, and understanding with a deep commitment to self-reflection.
It is essential that future and current chiropractic physicians be aware of the structural and functional aspects of an organization so that chiropractic and other health care professionals are able to deliver care that involves the ingredients of quality, affordability, availability, accessibility, and continuity for their patients.
The purpose of this article is to explore the postmodern, postrational, and postconventional core of DD Palmer's self-sense and philosophy.
DD Palmer's self and philosophy can be viewed as a reaction to the self of modernity and its challenges of a fracture between mind and body, spirit, and nature. It is argued that Palmer's solution to these vexing problems facing the modern self was to use postrational and postconventional logic to overcome the dualisms. His philosophy resonates with similar postrational approaches, most notably, the German idealist Schelling.
It is argued that Palmer was one of the first postrational individuals in America and that chiropractic was an attempt at the first postrational health profession.
Chiropractic; Philosophy; Vitalism; Metaphysics
The objective of this narrative review is to discuss the potential for burnout in chiropractic practitioners. This discussion is grounded in the job demands-resource model, the conservation of resources model, the unique profession-specific stressors experienced by chiropractors, and information from similar health care professions.
A search using both the indexed (PubMed and PsychLit) and nonindexed psychosocial literature was used. Other resources included the Cochrane Library, articles from governing bodies of the chiropractic profession, trade magazines, and research conferences and symposium proceedings. Articles were analyzed following the grounded theory principles: open coding and memos for conceptual labeling, axial coding and memos for category building, and selective coding for model building.
Potential stressors unique to doctors of chiropractic include factors associated with physical workload, role stress, and mental and emotional demands.
There are unique chiropractic-specific occupational characteristics that possibly contribute to burnout in the chiropractic professionals. These findings emphasize the need for assessing and measuring burnout and attrition within the chiropractic profession.
Psychology; Chiropractic; Manual therapy
One of the most commonly used eponymous terms in neuroscience and gross anatomy is Sylvius. The 2 most recognized uses of this term today are the sylvian fissure for the lateral cerebral sulcus and the sylvian aqueduct for the cerebral aqueduct. There is some controversy surrounding these terms because there were 2 famous anatomists named Sylvius after whom these structures could easily have been named. The purpose of this article is to provide a brief historical review of these 2 scientists and offer an observation on the historical use of the name Sylvius as an anatomical term.
Franciscus Sylvius was a popular teacher at the University of Leiden. One of his most famous students, Thomas Bartholinus, published F Sylvius' neuroanatomical work on the lateral cerebral sulcus. Although this structure had been known from antiquity, Bartholinus' description linked F Sylvius' name to the structure. As well, the description of the cerebral aqueduct was also published in other influential anatomy texts as an attempt by students to honor F Sylvius' name, despite the fact that this structure had been described more than a century before. Jacobus Sylvius was a successful but reportedly disliked anatomist at the University of Paris. Although he urged his students to learn from dissection rather than lectures or books, he had an unyielding devotion to Galen's teachings. His most famous student, Vesalius, went on to refute many of Galen's ideas as documented in his later publications. The rift between teacher (J Sylvius) and student (Vesalius) may have resulted in the marginalization of J Sylvius as a figure immortalized in anatomical texts. This may be the probable reason that J Sylvius' name is not associated with anatomical terms.
The lesson from this brief review of the 2 Dr Sylviuses may be that a teacher's historical legacy being preserved as an eponym may have more to do with his or her likability than productivity during his or her lifetime.
History; Anatomy; Neuroanatomy
The philosophy of chiropractic can be framed as an attempt to correct the problems inherited from the Western Enlightenment. Its origins can be found in the long tradition of Western philosophy. The purpose of this article is to describe in a broad context chiropractic’s roots in premodernity and establish the structural and hermeneutical differences between chiropractic’s original philosophical ideas and those of premodern philosophers.
The worldview or cultural mindset the philosophy arose from must be situated in the context of its time, the birth of the unique postmodern worldview, aperspectival consciousness, and the modern sense of self. This is accomplished by exploring several metatheories about the development of the self through history, with an emphasis on the premodern roots to the chiropractic terms; Universal Intelligence and Innate Intelligence. By contextualizing the philosophy of chiropractic in terms of a structural genealogy of the self and of ideas, a new approach to philosophy in chiropractic emerges.
Without accounting for chiropractic’s origins as a reflection of the unique time, place, and culture, in terms of the evolution of worldviews through history, any approach to construct or reconstruct a philosophy of chiropractic will potentially miss the seminal feature of chiropractic’s emergence.
Chiropractic; Philosophy; Vitalism; Metaphysics
The purpose of this article is to trace the foundations of DD Palmer's sense of self and philosophy of chiropractic to its sources in modern Western philosophy as well as current metatheories about modernity.
DD Palmer's sense of self was indicative of a modern self. A modern self is characterized as a self that developed after the Western Enlightenment and must come to terms with the insights of modernity such as Cartesian dualism, Spinoza's substance, Rousseau's expressivism, and Kant's critiques. It is argued that Palmer's philosophy can be viewed as part of the this tradition alongside his involvement in the 19th century American metaphysical religious culture, which was itself a response to these challenges of the modern self of modernity.
Palmer's development of chiropractic and its philosophy was a reaction to the challenges and promises of modernity.
Chiropractic; Philosophy; Vitalism; Metaphysics
The chiropractic profession struggled with survival and identity in its first decades. In addition to internal struggles between chiropractic leaders and colleges, much of our profession's formative years were stamped with reactions to persecution from external forces. The argument that chiropractic should be recognized as a distinct profession, and the rhetoric that this medicolegal strategy included, helped to develop chiropractic identity during this period of persecution in the early 20th century. This article questions if the chiropractic profession is mature and wise enough to be comfortable in being proud of its past but still capable of continued philosophical growth.
Chiropractic; History; Philosophy
The purpose of this article is to establish a metatheoretical framework for constructing a philosophy of chiropractic by using Integral Theory and Integral Methodological Pluralism. This is the first in a series of 3 articles.
The philosophy of chiropractic has not thrived as a philosophic discipline for multiple reasons. Most notably, these include disparate personal and cultural worldviews within the profession, a historical approach to chiropractic's roots, and an undeveloped framework for exploring philosophy from multiple perspectives. A framework is suggested to bridge divides and create a groundwork for a philosophical discipline using Integral Methodological Pluralism developed from Integral Theory. A review of the literature on the philosophy of chiropractic is mapped according to the 8 primordial perspectives of Integral Methodological Pluralism. It is argued that this approach to constructing a philosophy of chiropractic will bridge the historical divides and ensure a deep holism by pluralistically including every known approach to knowledge acquisition.
Integral Methodological Pluralism is a viable way to begin constructing a philosophy of chiropractic for the 21st century.
Philosophy; Chiropractic; Model, Theoretical; Methods
The purpose of this article is to relate information about the life of Dr William Ivens and describe the worldwide effort led by him to establish a chiropractic hospital at the Palmer School of Chiropractic.
Dr William Ivens, a colorful politician and chiropractor from Winnipeg, Canada, was the driving force behind the idea of establishing a chiropractic hospital at the Palmer School of Chiropractic in Davenport, IA, during the late 1930s. With the blessings of Dr BJ Palmer, president of the Palmer School of Chiropractic, Dr Ivens led an aggressive, worldwide campaign to raise the funds necessary to establish what was to be called the Fountain Head Chiropractic Hospital. During the tumultuous years of 1937-1942, this campaign successfully raised the target sum of $50 000, thought necessary to create the hospital, but the idea never became a reality. These funds were eventually used to purchase the Clear View Sanitarium, a chiropractic psychiatric facility, in Davenport, IA, in 1952.
Dr William Ivens stands as a prime example of a relatively small, but dedicated, number of chiropractors during the mid-20th century who not only believed in, but toiled for, the idea of chiropractic care being given in an in-patient setting.
Chiropractic; History; Hospitals
The appropriate role for chiropractic in US health care has not been established, but third-party payors and public policy makers must make decisions about the appropriate role for chiropractors in health care systems and for the services that chiropractors provide. Appropriateness studies for chiropractic may inform those decisions. The purpose of this article is to discuss the implications and limitations of appropriateness studies for chiropractic.
We reviewed the general context for assessment of the appropriateness and the application of appropriateness studies to chiropractic in particular. We evaluated the implications and limitations for chiropractic of methods of small area analysis and the RAND-UCLA Appropriateness Method. The RAND-UCLA Appropriateness Method has been applied to the evaluation of spinal manipulation. Regional variations in chiropractic utilization have yet to be described through small area analysis, but these methods appear to hold some potential for assessing the appropriateness of chiropractic care. Both small area analysis and the RAND-UCLA method offer limited possibilities for the assessment of chiropractic appropriateness.
Future assessment of the appropriate role for chiropractic in US health care will raise issues beyond the scope of previous appropriateness studies. Studying the appropriate role for chiropractic will require consideration of the clinical discipline in its entirety, rather than individual consideration of specific interventions. A fair assessment of chiropractic appropriateness will require new evidence and perhaps new research methodologies.
Chiropractic; Disease management; Utilization; Small area analysis
This commentary describes the debate and some of the associated issues involving the subluxation construct.
The long-standing debate regarding the chiropractic subluxation has created substantial controversy within the profession. Currently, this phenomenon can be compared with a country with a 2-party system that has a large silent majority sitting between the 2 factions. It is argued that the position held by those in the middle (the centrists) may be the most rational view when considering all of the available evidence. It is also suggested that the subluxation construct is similar to the Santa Claus construct in that both have a factual basis as well as social utility. Ultimately, the centrists must become proactive if they want to protect the profession and further advance the evidence in regard to the subluxation. They must not only engage in the debate, but fund the research that will investigate various aspects of the subluxation and then help disseminate this evidence to fellow doctors of chiropractic, other practitioners, health care policy makers, and society at large.
The role of subluxation in chiropractic practice, the progression of this debate, and the future of the profession will be directly determined by the role that centrists choose to play.
This article presents a personal view of the historical evolution of theories of subluxation in the chiropractic profession.
Two major themes emerge from this review: those related to the mechanical behavior of the spine and those related to the neurologic implications of these mechanical issues. Chiropractic subluxation theory is one of the few health-related theories whereby these mechanical and neurologic theories have been unified into a comprehensive theory of disorder of spinal function. For this disorder, doctors of chiropractic have used the term subluxation. These theories, and their unification in the “subluxation concept,” have undergone evolution in the profession's history.
The “subluxation concept” currently faces challenges, which are briefly reviewed in this article. The only way forward is to strengthen our efforts to investigate the “subluxation concept” with high-quality scientific studies including animal models and human clinical studies.
Chiropractic; Philosophy; Review
This article provides a brief review of the history and origins of the Journal of Chiropractic Humanities. The reason for starting the journal, its purpose, and a timeline from 1991 to 2009 are offered.
The purpose of this article is to use the steps described by Genson and Chun for implementation of electronic health records to determine the plausibility of implementation in a small private practice in northern Michigan.
A step by step approach was applied as described by Genson and Chun, which included discovery, planning, procurement, implementation, and support. Several challenges and obstacles were identified.
Electronic health records will eventually be a necessity, but they may not have matured enough to easily replace paper charts or to justify the expense for a single-doctor practice at this time. Each doctor should evaluate the needs of his or her practice for implementing electronic health records and weigh benefits and drawbacks prior to considering implementation.
Chiropractic; Electronic health records
The purpose of this study was to provide new information that describes chiropractors' professional identity relative to their perceived clinical role as specialist or generalist.
A pragmatic, descriptive, cross-sectional survey was performed of randomly sampled state-board licensed chiropractors in the United States during the period 2002–2003 to assess the chiropractors' perceptions of how their chiropractic patients see them, and how they see themselves, as specialist or generalist. For this exploratory study, we anchored the terms “back pain specialist,” “musculoskeletal specialist,” and “primary care generalist” to brief generic reference definitions in our survey instrument.
Of our 2598 valid survey contacts, 1343 chiropractors returned their surveys either partially or fully completed, and a total of 720 chiropractor surveys were used in this study. Most of these chiropractors perceived that their new patients viewed them as “back pain specialists.” Chiropractors believed that their established patients (80%), more so than their new patients (58%), were likely to view them as a primary care generalist. Chiropractors described themselves as both specialist and generalist, and they expressed a greater capability to diagnose, rather than to treat, health disorders that were not musculoskeletal.
Chiropractic physician perceptions as reported in this study suggest that the nature of certain chiropractor-patient relationships may evolve profoundly over time, particularly as patients transition from new to established patients within the chiropractic practice. Understanding the complex nature of chiropractic health care provision may carry implications for advancing evidence-based chiropractic practice and clinical training, enhancing successful and comprehensive management of the complex health concerns of chiropractic patients, fostering beneficial sustained partnerships between chiropractors and their patients, and improving overall delivery of optimal integrative health care.
Chiropractic; Health occupations; Back pain; Specialization
This article offers the author's opinions about some of the thoughts, words, and deeds of the profession's founder, Daniel David Palmer.
Reviewing D.D. Palmer's writings is challenging because he was the discoverer and founder of a developing profession and therefore his thoughts and words were rapidly evolving. Statements made by Palmer without judicious consideration of context could easily be misunderstood.
D.D. Palmer was individualistic and enigmatic. This commentary provides a look at the whole in an attempt to reveal the character and spirit of the founder.
Chiropractic; History; Spiritualism
The chiropractic profession is immersed in the process of professionalization with particular consideration of self-regulation as an avenue toward state recognition in Singapore. The purpose of this article is to discuss the emergence of chiropractic as a profession in Singapore and the Chiropractic Association (Singapore).
The concept of professionalization is varied and context based, and the institutionalization of formal knowledge plays an important role in the socialization of how a profession forms a unifying identity. The difference in institutional socialization of the professions plays a role in the way a profession is perceived in the hierarchy of societal power. Continuing professional development is an essential part of professionalism and is best done within the realm of self-regulation and autonomous control of the profession itself.
The social process of professionalization can be a process of internal conflict and external battles almost from the profession's inception with university training only entering late in its development, rather than being a linear development. A sequential progress ensued as with other professions, with the seeking of legal protection and a code of ethics as the final areas reached toward becoming an acknowledged member of the health care system.
Chiropractic; Health occupations