Science vs. scientism
by Dr. Christopher Kent
A perception that medicine is "scientific" and chiropractic
is "unproven" seems to pervade a growing element of our
profession. This perspective has resulted in a low perceived
value of our unique principle and practice.
Science provides investigators with a useful method of
inquiry. Scientific methods have led the healing arts out of
the world of anecdotal observation, myth, and superstition.
However, doctors must not lose sight of the fact that
science may not be the only valid method of inquiry.
Furthermore, it must be realized that while predictability
may be considered in designing clinical strategies, all that
ultimately matters is what is effective for a given patient
in a specific circumstance. Educational institutions
producing health care providers must guard against
graduating practitioners who are automatons following flow
charts rather than thinking, feeling, human beings.
Although science is not an enemy of chiropractic, scientism
most certainly
is. Scientism limits all fields of human inquiry to
contemporary technology. Smith states that scientism
"...refers to an uncritical idolization of science --
the belief that only science can solve human problems,
that only science has value." Holton observed that
"Scientism divides all thought into two categories:
scientific thought and nonsense." (1,2)
What's wrong with that? A practitioner of science 100 years
ago would be forced to declare cosmic waves, viruses, and
DNA "unproven" concepts. Such a scientist, bound by the
limitations of the technology of the times, would be unable
to "prove" or "disprove" the existence of such things. Our
hypothetical scientist might go one step further and deny
the possibility of their existence, active as some of them
may have been in the dynamics of health and disease!
Scientism is a scourge which blinds the visionary and
manacles the philosopher.
Aldous Huxley was acutely aware of the folly of limiting all
human inquiry to the scientific method. He stated, "The real
charm of the intellectual life -- the life devoted to
erudition, to scientific research, to philosophy, to
aesthetics, to criticism -- is its easiness. It's the
substitution of simple intellectual schemata for the
complexities of reality; of still and formal death for the
bewildering movements of life."
(3) Science has a place in chiropractic -- scientism does
not.
Just as scientism limits human inquiry to available
technology, bad science, characterized by questionable
research designs, leads to faulty conclusions. For example,
some critics of chiropractic claimed that it was impossible
for subtle disrelationships termed "subluxations" to produce
enough pressure on neural structures to alter their
function. Through a process of "rationalism" based on animal
studies, and a poorly designed study using human cadavers,
it was concluded that chiropractic theory was false. (4)
The point is simple. Bad science leads to faulty
conclusions. And any scientific inquiry is limited by the
technology available to the investigator, the design of the
experiment, the analysis of the data, and the conclusions
drawn from the data. In short, if you can't reliably measure
something, you can't investigate it scientifically.
That's fine, unless you are trying to investigate something
for which reliable and valid measurements have not or cannot
be devised. For instance, we cannot measure innate
intelligence. Does this mean that it is not "real" and that
we should abandon the concept merely because we have no
technology to detect or quantitate it? I think not.
Baruss wrote, "If we are serious about coming to know
something, then our research methods will have to be adapted
to the nature of the phenomenon that we are trying to
understand. The purpose of science should take precedence
over established methodologies...Similarly, belief in a
universal, inflexible scientific method that can guarantee
truth belongs to scientism. If one is authentic, one's
effort to develop one's understanding by changing opinions
into questions may cut so deeply that traditional research
methods themselves are called into question and are replaced
by others that serve one's purpose better. One may need to
draw on the totality of one's experience and not just on
that subset that consists of observations made through the
process of traditional scientific discovery."
(4)
Our profession has very limited research resources. To our
credit, we have done a phenomenal job with what we have.
Unfortunately, there is a growing trend in chiropractic to
embrace allopathic research designs emphasizing symptomatic
rather than physiologic change. A plethora of projects are
attempting to determine if "manipulative therapy" is
effective in ameliorating back pain and other symptoms.
Many of these designs are inherently flawed in that they
fail to adequately define the nature of the intervention
applied (a basic adjustment is quite different from an atlas
toggle or a lumbar roll). Worse, from a philosophical
standpoint, symptoms are used as outcome criteria rather
than the correction of subluxations.
It is sometimes argued that in the absence of reliable and
valid indicators of subluxation, subluxation-based outcome
evaluation is impossible. Indeed, this is where our initial
research efforts must be directed. Developing technologies
to reliably assess the clinical manifestations of vertebral
subluxation is a high priority item. It is not an excuse,
however, for failing to use existing technologies which can
reliably evaluate manifestations of the vertebral
subluxation.
Fortunately, social scientists have developed "paper and
pencil" instruments to assess patient-perceived wellness and
quality-of-life issues regardless of whether specific
diseases or identifiable symptoms exist. Such tools may not
find favor with mechanists who idolize the randomized
clinical trial.
Chiropractic research is in very real danger of succumbing
to the scientism so pervasive in the allopathic community.
And by copying the experimental designs of the symptom-
oriented allopathic model, chiropractic's unique non-
therapeutic approach may be lost.
I have heard many chiropractors parroting the misconception
that patients and insurance companies will only pay for care
rendered to symptomatic patients.
Such utter nonsense has caused many to promote the notion
that D.C.s should treat pain syndromes only. In fact,
chiropractic may be the only health care discipline which
sports a faction that does not consider early detection of
an asymptomatic, progressive process a virtue, if not a
necessity.
Abnormalities can exist in the absence of symptoms! Consider
asymptomatic breast cancer, asymptomatic dental caries, or
the "silent killer" hypertension. Basing outcome assessments
for these conditions on patient symptomatology would have
disastrous results.
I find it repugnant to force an asymptomatic patient to wait
for pain to manifest before receiving an adjustment.
Clinical strategies must be based upon subluxation-based
outcome assessments which address aspects of health beyond
the amelioration of symptoms.
References
5. Smith RF: "Prelude to Science." Charles Scribner's Sons.
New York, NY, 1975. P. 12.
6. Holton G: "The false images of science." In Young LB
(ed): "The Mystery of Matter." Oxford University Press.
London, UK, 1965.
7. Huxley A: "Point Counter Point." Quoted in Smith RF,
op cit P. 8.
8. Crelin ES: "A scientific test of the chiropractic
theory." Am Sci
8(1):574, 1973.
9. Baruss I: "Authentic Knowing. The Convergence of Science
and Spiritual Aspiration." Purdue University Press. West
Lafayette, IN. 1996, pp 40-41.
(Dr. Christopher Kent, president of the Council on
Chiropractic Practice, is a 1973 graduate of Palmer
College of Chiropractic. A member of the Board of
Directors of the World Chiropractic Alliance, he
received the WCA's "Chiropractic Researcher of the
Year" award in 1994. Recipient of the same honor from
the International Chiropractors Asociation in 1991, he
was named ICA "Chiropractor of the Year" in 1998.
Ds. Kent is director of research for EMG Consultants, Inc.,
and a co-founder of Paradigm Partners, Inc. and the
Chiropractic Leadership Alliance. With
Dt. Patrick Gentempo, Jr., he produces a monthly audio tape
journal, "On Purpose," covering current events in
science, philosophy, and politics of vital interest to
the practicing chiropractor. For subscription
information call 800/892-6463.)