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ABSTRACT
Objective: To discuss the professional identify of
chiropractic as evident in the profession’s literature.
Methods: Structured literature review followed by a
pragmatic historical narrative of found artefacts.
Results: The literature appears vague regarding
chiropractic’s identity.
Discussion: The literature does allow a broad
determination that the identity of chiropractic is uni-
modal gathered around the founding premise of DD
Palmer with an informed prediction of a left-skewed,
negative distribution of concessional chiropractors
representing no more than 30% of all. It appears this
minority becomes more dogmatic as it concedes elements
of conventional identity and adopts extreme evidence-
based musculoskeletal medicine to become a sect of
about 0.2% of all. About 70% of chiropractors identify
with subluxation in an evidence-informed context and
I call this representation the conventional chiropractic
identity.
Conclusion: The identity of chiropractic may now be
descr ibed as conventional when its practitioners adhere to
the profession’s founding precepts, or concessional when
it modifies or ignores these. The majority of the profession
can be considered conventional. (J Contemporary Chiropr
2020;3:111-126)
Key Indexing Terms: Chiropractic; Identity; Subluxation.
INTRODUCTION
The premise of chiropractic is straight forward; subluxed
vertebrae compromise the nervous system, modulating
tone and the resultant state of Wellbeing. (1, pp 404, 632,
656, 659) Variants of this idea are found throughout the
medical literature of the 16th through 19th Centuries
(2,3) and the chiropractic literature of the 20th Century.
(4)
Palmer’s original contribution was the use of the
spinous and transverse processes as levers to manually
replace subluxed vertebra (5), thus avoiding the painful
medical approach of cauterizing with a hot iron, without
anesthetic, to create a blister over the spinal segment or
creating painful irritation with surgical incision. (6-8)
His new method to correct a subluxed vertebra became
known a s the chiropractic adjustment and these behaviors
indisputably constitute conventional chiropractic (9)
notwith-standing a vocal minority who think otherwise.
(10) That which Palmer founded as ‘adjusting by hand’
(11) is now colloquially known as ‘cracking backs.’ (12)
One would think the practice of manually adjusting
subluxation would form a consistent identity for the
profession Palmer founded but this was not to be. In his
mid-1990s thesis (13) exa mining ch iropractic in Aus tralia,
sociologist O’Neill noted ‘the deceptively simple question
“what is a chiropractor” still lacks a definitive answer.’
(14) The same question had been posed 20 years earlier
by Haldeman, who came to be an eminent member of
the profession. He asked ‘what is a chiropractor, and
what does he do?’ (15) Not one of a recent series of 13
papers addressing the question ‘what is chiropractic’ and
reporting ‘papers describing the chiropractic profession
and chiropractic practice’ addressed identity. (16, Table 1)
This question would be answerable with a common
professional identity that did not distinguish between
the discipline as a body of knowledge forming the science
of chiropractic, and the profession as the group of people
engaged or qualified in expressing that knowledge,
based on standards of practice, codes of ethics and
of professional conduct. It is the lack of a professional
identity gathering these that the evidence shows to allow
contemporary counterfactual argument within and
about chiropractic.
This paper applies the methods of a pragmatist to
examine chiropractic’s professional identity by con-
sidering a historical context for adjectives descriptive of
chiropractors, such as ‘straight’ or ‘mixer’, and ‘dogmatic’
or ‘evidence-based.’ Australasia allows a case study
of identity as it developed outside North America, the
founding home of the profession. In Australasia the
delineating terms are ‘main-stream’ and ‘second-stream.’
(17)
This paper addresses the research question ‘what is the
professional identity of chiropractic’ and will identify
the terms ‘conventional’, ’concessional’, and ‘negative
left skew’ as appropriate descriptors in the 21st Centur y,
J Contemp C hiropr 2020 , Volume 3
THE CONVENTIONAL IDENTITY OF
CHIROPRACTIC AND ITS NEGATIVE SKEW
Phillip Ebrall BAppSc(Chiro), DC (Hon), PhD, PhD(Cand).1
Journal of
Contemporary
Chiropractic
JCC
1 Chiropractic writer, Asia.
Chiropractic Identity
Ebrall
111
J Contemp C hiropr 2020 , Volume 3
Chiropractic Identity
Ebrall
formalizing the split identity that emerged during the
first decade of the profession.
METHODS
The literature of professions was searched to establish a
contemporary interpretation of ‘identity’ in the conte xt
of a health profession. The discipline’s literature as
indexed by the Chiropractic Library Collaboration (18)
was searched for primary data, and secondary data were
found by citation harvesting of returned papers from
the initial search. The standard assessment processes
used by historians to validate found papers and related
resources were applied. Primary sources were evaluated
by understanding who wrote it, what questions were
addressed, and why? (19) The 6 evaluative questions
identified by Garraghan (20) to validate historical
artifacts were consistently applied to all papers.
The initial search term was ‘identity’ and I report that the
literature does not return a common, shared professional
identity for the chiropractic profession; also, that various
professional bodies including the Word Federation
of Chiropractic (WFC) lack commonality in their
understanding of the profession they represent.
RESULTS
The Matter of Professional Identity
In general a profession is an occupation based on skill or
education (21) where the holder has autonomy. (22) The
themes of professional identity are given as ‘selflabeling
as a professional, integration of skills and attitudes as a
professional, and a perception of context in a professional
community.’ (23) Chiropractic appears as a profession to
the public (24-26) and to healt h-care pee rs. (27) Given th at
chiropractors exist under legislation in over 40 countries
(28,29) they are considered as health practitioners and
the occupational regulators and education accreditors
are overt regarding the need to demonstrate professional
skills and attitudes. (30) Indeed, ‘Universal Competency
1’ of the Council on Chiropractic Education Australasia
(CCEA) is ‘Practicing Professionally’. (30 p. 10)
The Matter of Chiropractic Identity
Different positions within chiropractic are shown to have
different ideas of what chiropractic is or should be (31-34)
Individual opinions (35,36) range from it being a drug-
free (37) wellness profession (38) treating beyond the
spine (39) to only a spine-care profession with manual
methods, (40,41) or, in a basic form, centering on the
analysis and adjustment of vertebral subluxation. (42)
The literat ure offe rs few publi shed intel lect ual cons tr uct s of
chiropractic identity beyond the unimodal position given
in my introduction. Arbitrary positions are promoted by
most commentators with presumed authority and I offer
this critique on the basis of my systematic analysis of the
chiropractic literature undertaken in March 2019 using
the search string ‘papers given as first-level related from
chiropractic [mesh] AND (sublux ation [ti] OR sublux ation
[ab])’ in the form ‘“chiropractic”[MeSH Terms] AND
(subluxation[ti] OR (“joint dislocations”[MeSH Terms]
OR (“joint”[All Fields] AND “dislocations”[All Fields])
OR “joint dislocations”[All Fields] OR “subluxation”[All
Fields]))’. 101 papers were returned and all were one or
more of opinion, cohort studies with ill-defined terms,
literature reviews, or other.
As a pragmatic historian and educator I argue that
vagueness envelops the professional identity of
chiropractic. My use of the term ‘vagueness’ is after
Swinburne’s examination (43) and includes inexactness
and imprecision, qualities that are appropriate to describe
ongoing argument over basic clinical procedures within
chiropractic. To demonstrate polar divergence I present
2 examples: a conflict regarding the role of radiography,
and actions by a minority to become part of medicine
complete with prescribing rights for listed medications.
The Radiography Cleft
With regard to the clinical use of radiography in
chiropractic practice there are 2 strongly held oppos-
ing views. I accept this as evidence of a heterogeneity of
clinical ideas within the profession. (44-52) My critical
interpretation of this heterogeneity is the dissent by 1
group from the opinion of another regarding clinical
radiography.
The evidence in this case reveals 2 quite different
standards (53-56), each cla iming to be best pract ice for the
use of diagnostic imaging in clinical chiropractic. Both
groups claim to be evidence-based, with 1 aligned with
evidence seen through a biomedical lens and the other
with evidence seen through a lens of chiropractic clinical
practice. In turn, this leaves educational institutions
presented with a choice between 2 conflicting versions
of evidence, (57) if indeed a choice is needed to teach
clinically-based practice standards regarding chiropractic
radiography or the medical view where the diagnostic
intent of imaging is different. The debate is acrimonious
(46) and ad hominem. (58)
The pragmatist’s perspective is that the clinical
chiropractic view predates the biomedical view by
decades and that pre-treatment radiographs provide
important clinical information. Some consider they
are required for safety (59-61) while others consider
otherwise. (62) A critical analysis of the biomedical
approach promoted by the WFC suggests flaws in its
basic understanding of clinical chiropractic practice
by applying the standards of medical care to a patient
under chiropractic care. (63) The inability to understand
this distinction seems to underpin the WFC’s position
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Chiropractic Identity
Ebrall
in another matter (64) and I make this point here as it
appears the contemporar y divided professional identity
can be resolved to being 1 of 2 interpretations of clinical
practice as a chiropractor. These are either a conventional
view through a chiropractic lens or a concessional view
through a medical lens.
The Medicine Cleft
The complexity of the argument about seeking medical
priv ileges such as is suing prescr iptions for pharmaceut ical
products is such that this paper can only make the briefest
notation that it seems to stem from one or two colleges
(65,66) embracing the idea that chiropractic is medicine.
My brief summation will commence with a journal that
arose independently, in Illinois in 1988. The American
Journal of Chiropractic Medicine closed after three years of
attempting to establish a field of ‘chiropractic medicine’.
In spite of being a peer-reviewed, indexed journal with
appropriate processes and an established editor it came
to an ignominious end. The editor, Roy Hidlebrandt, a
1949 graduate of Palmer College, had previously worked
with Janse of the National College of Chiropractic (NCC)
to establish the Journal of Manipulative and Physiological
Therapeutics. (67) Throughout its 12 issues the Am J Chiropr
Med argued its need to exist however the profession
thought otherwise and did not embrace it.
NCC, which reinvented itself as a health science
university, now delivers chiropractic education as ‘a
doctor of chiropractic medicine.’(65) The institution has
taken this program to Florida (68) which has caused
consternation in that state among other institutions
competing for the chiropractic-student-dollar. (69)
Further, NCC as a university is trying to revive the idea
of a journal of chiropractic medicine. (70) Its readership
is not known and the lead paper in the June 2019 issue
was to do with physiotherapy applied to the viscera,
(71) a discipline and a clinical approach traditionally
not considered chiropractic nor even a variant within
Palmer’s founding ideas; (72) the September 2019 issue
strays into osteopathy. (73) As another example, Kaiser
University states ‘Our vision is to be the nation’s leading
school of chiropractic medicine.’ (66)
This ‘medicine’ cleft is between those chiropractors
who consider chiropractic to be the conventional form
established by Palmer as the identification and correction
of subluxed vertebrae and those who concede Palmer’s
founding principles and seek to create their own variant
of the discipline. From this observation I derive my
categories ‘conventional’ and ‘concessional.’ In Australia
these positions were manifest as ‘mainstream’ (74) where
training occurred in a North American chiropractic
college, and ‘second-stream’ (75-79) when it did not,
requiring self-proclamation to claim an identity as a
chiropractor. (80)
I summa rize t hese 2 positions by sugg esting a chi ropractor
may either be an expert in spine-mediated health and
well-being which frames their approach to health care in
a conventional chiropractic manner, or they may take a
position of being a manual therapist with some training
in chiropractic and see the patient through medical eyes
as a diseased or injured person to be managed. This is
disease care, the province of medicine. (81)
DISCUSSION
Chiropractic Identity as Founded
Palmer’s belief system held his approach as pure (72) on
the basis he founded and developed it; in this sense it
can be only this foundation concept of chiropractic that
is able to be considered as conventional chiropractic; all
else is a modification, addition, or a concession of some
aspect.
Palmer’s early graduates were also cer tified to teach
his methods and this quickly gave rise to a number of
different colleges. (82-85) In at least 1 case his graduates
formed another discipline, naprapathy. (86) Oakley
Smith, an 1899 Palmer graduate (87-89) and Solon
Langworthy, another early graduate (1901, 90 p. 38)
founded the American School of Chiropractic in Cedar
Rapids, (91) nearby to Palmer’s school. They co-authored
the profession’s first recognized text. (92) Their teachings
were a mixture of chiropractic and osteopathy and it was
this that caused Palmer to coin the term ‘mixer.’ He wrote
‘if you wa nt a mixt ure of Osteopathy, Ort hopedial Sur gery,
Vibratory Chiropractic and Bohemian treatments, go to
Cedar Rapids …’ (72 p. 6)
In 1914 (1) Palmer made his view known that structure
and function were closely related, writing ‘Behind all
abnormal f unctions, i s the change in t he struc ture of nerve
tissue and an increase or decrease of nerve vibration.’ (p.
28) ‘Normal structure’ and ‘normal vibration of nerves’
is denoted by ‘tone.’ (p. 32) Others (93, pp. 8-13) have
reinforced the intimacy of function with structure, in
particular small changes termed subluxation that occur
between contiguous vertebrae. The clinical behaviors
around that premise establish chiropractic as a narrated
phenomenon and warrant my approach as a pragmatist
to seek meaning among these various narratives.
Chiropractic as an Entity Today
Chiropractic is a reality through its commonalty as a
ubiquitous health-care practice in some 91 countries
(94) with the most recent to introduce legislation
being Lebanon. (95) Globally there are about 105,000
practitioners, with most practicing under legislation.
(28,29) This statutory identity provides the boundaries
for the relevant occupational regulator. In the global
sense chiropractic is recognized by the World Health
J Contemp C hiropr 2020 , Volume 3 113
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Ebrall
Organization (WHO) (96) which outlines a range of basic
training requirements. A number of conditions treated by
conventional chiropractors, notably subluxation, (97,98)
are given in the International Classification of Diseases Tenth
Revision, Clinical Modification (ICD-10-CM). (99)
Expressions of Chiropractic Identity
The most simplistic interpretation has been addressed,
that of ‘straight’ or ‘mixer’ together with its origin. This
bimodal polarity was used in the 1960s by the American
Medical Association (AMA US) as a means to disempower
chiropractic. (100) Interestingly, Throckmorten had little
concern for straight chiropractors; as legal counsel to the
Iowa Medical Society he warned the ‘mixers’ were more
of a menace to medicine. (p. 6 Section F)
Today an extension of this identity is presented by
chiropractors from a vocal minority calling for medical
prescription rights. (101,102). To counter this, the
International Chiropractic Association (ICA), an affiliate
of the WFC with the potential to be an alternative
global association, has issued a public statement to
oppose expanding the chiropractic scope of practice to
include the prescribing of ‘dangerous drugs.’ (103) It is
a relatively straightforward conjunction to suggest those
chiropractors wishing to practice chiropractic as part
of medicine are placing themselves in a concessional
position which by definition is weaker than maintaining
the conventional chiropractic position of being distinct
from medicine.
In contrast to the dichotomous ‘straight/mixer’ identity,
Wardwell, a noted (13) American sociologist, thought
of chiropractic that the profession showed a Gaussian
distribution of identities. (104) I represent his concept
in Figure 1 using imagined data drawn from estimates
by Jamison, (105) Good, (106) Kent (107) after Edwards,
(108) and Coulter. (109) The literature consistently
reports the majority of chiropractors as holding views
about subluxation and of the value of evidence and I
depict this as ‘conventional,’ forming the peak of this
cur ve. The empirical rule (110) says about 68% of a
normal distribution gathers around this central peak,
leaving a left tail and a right tail. Chiropractic shows
a small group that statistically fall as the left tail,
progressively rejecting subluxation and insisting only on
providing their interpretation of evidence-based care. In
Figure 1 I term this tail ‘concessional,’ representing those
chiropractors who concede the foundation premise of
chiropractic.
Wardwell’s idea had merit at the time he coined it, as the
literature of that period shows hard-core tails that were
a concern in the 1970s and ’80s due to the presence of
dogmatic ‘straight’ positions. (111-113) However it has
not been possible to locate current evidence of a right-
tail; 1 of the papers returned is a 1996 commentary in a
trade magazine by Seaman (‘Who are the left-wing and
right-wing chiropractors?’) (114) that concluded as I do
that there is no ‘right wing.’ He also concluded there is no
‘left-wing,’ which seems correct in today’s terms.
I cannot make any scholarly argument that supports a
Gaussian distribution; rather, the evidence is emerging to
better understand the unimodal distribution. Richards
(115) surveyed Australasian chiropractors to seek their
self-categorization from a range of choices of how they
viewed their practice style. In very broad terms he found
the majority supported a vitalistic view and a minority a
mechanistic view. He reported (115) that the mechanistic
minority reject vitalism perhaps because of seeing it as
a hindrance. (116) To qualify as bimodal these 2 groups
would need to be either or about the same size, (117)
individually cohesive, and ‘have a fair gap between them
… not just random fluctuations.’ (118)
The more recent findings of Glucina et al (119) reflect
Richards’ distribution, ‘vertebral subluxation is an
important practice consideration for up to 70% of
chiropractors.’ Should this majority be considered as
representing the ‘conventional’ distribution shown in
Figure 1 as about 68% (rule of thumb), the tail towards
the lef t would represent the biomechanical, non-vitalistic,
concessional grouping, representing at most about 30%
of the profession. The resultant left-skewed distribution
leaves the majority of the profession, about 70%, grouping
towards the right as conventional chiropractors, tailing
to-wards the negative left as chiropractic’s founding ideas
are progressively jettisoned.
In Figure 2, I attempt to show this distribution as a
114
Figure 1. Putative Gaussian distribution of chiropractic
identity, after Wardwell, (104) Jamison, (105) Good (106)
Kent (107) and Coulter (109)
Figure 2. Predictive left-skewed distribution of chiropractic
identity presented in this paper
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predictive curve should my findings in this report have
substance. Of interest is the placement of the mode which
a skewed, unimodal distribution allows. The mode is a
representative value as the measure of central tendency
and as such it is the ‘thought position’ around which the
data is centered. In this representation I show the identity
of chiropractic as unimodal and conventional. The tail
must be seen as an aberration, perhaps suggesting a
fragile nature likely to fracture from the mainstream,
conventional chiropractic identity. This probability has
been canvassed. (120-122)
The evidence retur ned for this paper shows there are many
opinions as to what the identity of chiropractic could be
and these fall either on the side of Palmer’s founding
concepts (vitalism), or outside them (mechanism).
conventional or concessional.
The Rosner Categories
Rosner, a biochemist with an understanding of
chiropractic, published an identity structure drawn
from his examination of the literature and summarized
in Table 1 with my added clarifications. (123) Rosner’s
proposition characterizes a profession of complexity
with 6 traits that seem to form the shape of conventional
chiropractors as they exist in this 21st Century.
It is straightforward for a chiropractor to consider each of
Rosner ’s charac teristic s and determine the ex tent to which
they practice in this manner or not. The literature suggests
that concessional chiropractors would rank low against
numbers 3 and 4 with ambivalence about numbers 1 and
2. The reduction of this grid to just 2 points, numbers 5
and 6, ser ves to distinguish a concessional chiropractic
identity from the conventional.
The literature shows a small subset of about 10
chiropractors who completely reject subluxation in
addition to the Research Committee of the WFC
(46,50,51). Members of the WFC Research Committee
resigned en masse at the time of writing this paper and the
professional destination of those former members is not
yet publicly known. In addition to these, the following
have published concessional views: Walker, (120) Mirtz,
(121) Reggars, (124) Simpson, (125) Young (126), Perle,
(127) and Mirtz with Perle. (128) Walker and Perle hold
influence as journal editors. (129) Together with 37 self-
proclaimed ‘expert chiropractors’ (130) and some 150
‘signatories’ to a specific position of chiropractic politics,
(131) these some 200 concessional practitioners represent
approximately 0.2% of all chiropractors.
There is also a tangential thread of Danish thought
unraveling from what the literature shows is the
conventional practice of chiropractic in Denmark. (132)
The profession has developed in Denmark regardless
that ‘government’s dualistic action relative to the
Danish chiropractic community’ may have ‘inhibit(ed)
the spontaneous evolution of contemporary Danish
chiropractic practice.’ (133) Its characteristics include
nearly half (47% in 2014) (134) of practitioners being
trained locally at the country’s only chiropractic training
program delivered as ‘Clinical Biomechanics’ (135) and
developed to build the profession’s legitimac y. (136) As
expected the management of low back pain accounts
for around half (49%) of all patient visits. (137) Within
the Nordic region both maintenance care (138) in the
absence of evidence beyond ‘reasonable consensus’ (139)
and infant care is common (140) including for infantile
colic, (141) a practice cautioned against in Australia (142)
with the suggestion that such practitioners require ‘a
minimum 2 years of post-graduate training in pediatrics’
and Board endorsement. (143)
This unraveling from the conventional is concessional,
dogmatic ‘evidence-based musculoskeletal medicine’
(EBMM)* which sits outside scholarly debate and offers
extraordinary propositions (122,144) which have been
countered with argument (145) from philosophical
115
Rosner Criterion Expression in conventional
chiropractic
1. Concepts of
manual medicine
The contect of an holistic approach to the
body as an integral whole, greater than the
sum of its parts, within ailments may be
managed without drugs or surgery.
2. Areas of interest
beyond the spine
An understanding that the spine is central to
the functioning of the total individual and is
reflected in the state of the individual’s health,
both actualised and potentiated.
3. Concepts of
the chiropractic
subluxation
An understanding of the functional anatomy
and neurophysiology of the spinal motion
units and other joints with acceptance
that these may become dysfunctional and
potentially correctable by manual intervention
primarily as spinal adjustment.
4. Concepts of
neurology
An appreciation of neurology in the domains
of objective findings (motor, reflex, sensory)
subjective reports (sensation, pain, autonomic
responses) and abstract dimensions
(cognitive, affective, evaluative).
5. Concepts of
mainstream or
alternative health
care
Unfettered public access, typically under
jurisdictional legislation.
6. Concepts of
primary care,
first-contact
provider, or
specialist.
Allowance of practitioner choice from solo
private practice to being a member of a health
care team.
Table 1. Traits of conventional chiropractors after Rosner (123)
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pragmatists in the Eastern tradition, and from the
conventional position. (146) That attitude sits outside the
conventional or mainstream model of chiropractic and
is contrary to much evidence, clinical experience, and
patient initiated reports and observations.
This internal Danish inconsistency reflects from the WFC
Research Committee (147) with some members signaling
a shift away from the conventional position. There is a
media report (148) that the behavior of this thread was
an embarrassment to the profession at a global meeting
in Berlin in 2019. The ICA has formally complained about
this to the WFC on more than 1 occasion. (149,150) The
behavior is seen as a reason for financial supporters of
the WFC to reconsider their position. (151)
On the other hand the ICA represents conventional
chiropractic (152) in contrast to the WFC which has
adopted a concessional model by putting aside an
identity of chiropractic it developed through extensive
consultative processes (153) and instead adopting
‘principles’ of professional behavior (154) reflecting
the ideologies of its contemporary leadership group.
None of the 20 principles adopted by the WFC provide
a professional identity; starting from their Principle One
(1) ‘We envision a world where people of all ages, in all
countries, can access the benefits of chiropractic’ they
proceed through a non-evidence-based series of emotive
statements with none capable of being a statement of
identity for the profession they claim to represent. In stark
contrast the World Chiropractic Alliance (WCA) (155)
sees an identity of chiropractic as ‘the only discipline
that focuses on correcting subluxations and reducing
the stress that interferes with the body's ability to self-
regulate and heal.’
So What is Chiropractic?
In the absence of the literature returning an agreed
identity of chiropractic alone a theory of chiropractic,
(156) the profession is commonly described in terms of
different paradigms. (157-160) This presents a dilemma
for educators (161) and in the Australasian context
there is divisiveness among Australasian educational
institutions in the absence of an agreed paradigm of
chiropractic that the accrediting body, the CCEA, (30)
fails to address. Even the paradigm proposed by the
Association of Chiropractic Colleges (ACC) (162) seems
to have failed in uniting all colleges in the countries of
its members. (163) Paradigm or not, the literature of
chiropractic demonstrates vagueness with the matter of
professional identit y. (164)
This lack of a common agreement of the professional
identity of chiropractic may explain the existence of 3
professional associations (165-167) in Australia and a
fourth in New Zealand. (168) When the New Zealand
Association was first established in 1921/22 (169,170) it
included the few US-trained chiropractors in Australia at
the time but this did not last. The first formal chiropractic
association in Australia was founded also by US-trained
chiropractors, in 1938. (171)
Identity in Australasia
The introduction of legislation in Australia in particular
brought 2 disparate groups together, (17,81) the
chiropractor trained in North America, commonly
at Palmer College, and considered mainstream by
commentators, (80 p. 79 Table 2.3.1,172-177) and the
practitioner trained in Australia, usually in naturopathy,
then osteopathy and eventually chiropractic. Researchers
have consistently classified these as ‘second stream’ (77-
80,178,179) although this term is not welcomed by those
(180) who may fit the category. (181,182)
Through the Grandfathering process at the time the
statutory register was opened state by state, those states
with a second-stream cohort allowed any person with
an established practice to nominate themselves as a
chiropractor or osteopath or naturopath and commonly
all three. Only one state, Western Australia (WA), is noted
(80) for holding a strict position on the required level
of education to allow registration, limited to graduates
from the United States and Australia’s first accredited
chiropractic program (183) at the Phillip Institute
of Technology, Melbourne (PIT). The implication is
that WA established chiropractic as a mainstream or
conventional profession, an anomaly now the state is
served by a local program at Murdoch University which
teaches concessional chiropractic as evidenced by it
being a signatory to the position statement relegating
subluxation to history by the International Chiropractic
Education Collaboration (ICEC). (184)
Broadly speaking, as chiropractic was settled in Australia
the American-trained chiropractor graduated from a
conventional mainstream program and the Australian-
trained did not. Mainstream is defined by Peters and
Chance as ‘the philosophy, sciences and art of c hiropractic
from its discovery by DD Palmer in 1895 in Davenport
Iowa, through its development at the Palmer School
of Chiropractic by BJ Palmer, and at other chiropractic
colleges, dealing with spinal relationships and
neurological in-tegrity and taught in residential courses
at standards acceptable to the statutory examination and
registration authorities of the day (primar ily in the United
States and Canada.’ (179) By exclusion the definition of
second-stream is chiropractic that is not mainstream and
includes manipulation called ‘chiropractic manipulation’
‘by medical practitioners, physiotherapists’ and others.
(185,186)
This distinction continues today with 2 Australasian
institutions (187,188) formally relegating the
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subluxation as ‘only of historical interest’ and just two
(189,190) of the remaining four claiming to deliver a
curriculum that includes all 6 of Rosner’s traits. Second-
stream chiropractors now lead 3 of the 4 professional
associations, (191-193) with New Zealand being the
exception. (194)
How Did This Happen?
The development of chiropractic as mainstream and
second-stream in Australasia is addressed in detail
by me elsewhere. (17,80) In brief, the profession in
Australia developed under the auspices of chiropractors
trained at the Palmer school in America, representing
the mainstream of chiropractic. A second-stream of
self-proclaimed therapists variously as osteopaths,
chiropractors, or naturopaths, or all three, formed a small
collective of questionably trained practitioners, some of
whom who persist today. Australasian education was
based on models put forward in 1975 by Winter (171)
and the main-stream association. (195) The purpose
of Winter’s report was to provide the curriculum for a
university-level program of chiropractic education for
which the entry level was matriculation to address what
he saw as the lowest possible standard for registration
being set by an inquiry conducted by the state of New
South Wales (NSW). (196)
The NSW Inquiry recommended ‘broadly, that all
practitioners who manipulated, provided they had
been in practice for 4 years, should be registered as
chiropractors.’ (196 p. 7, 3.1.3) It is this abrogation of
a reputable standard of education which informs my
understanding of concessional chiropractic as being that
form of chiropractic which concedes or omits the Palmer
foundations a nd at 1 time in Aus tralia i ncluded osteopat hs,
naturopaths, and untrained persons; the model endorsed
by the NSW recommendation. That ‘second-stream’ of
chiropractic could be today’s ‘concessional’ chiropractors
as evidenced by the published narratives as shown in
this paper.
CONCLUSION
Regardless of my axiological bias toward Palmer’s
founding idea the evidence shows that chiropractic may
be considered as a unimodal profession, one that gathers
about Palmer’s founding imperatives with some who
progressively reject them and tail away to a concessional
identity which at its extreme represents EBMM Note:
The term ‘evidence-based musculoskeletal medicine’ or
EBMM emerged during the peer-review process and I
adopt it as a descriptor of concessional chiropractic.
There is no more appropriate term than ‘conventional’ to
describe evidence-based chiropractic in the mode of the
founder’s intent. The 6 Rosner traits (Table 1) represent
an appropriate characterization of conventional
chiropractic. The literature reveals that there are
chiropractors including those who are closely associated
with a global body of national associations (WFC) that
concedes that Palmer’s ideas have no contemporary
credence. The most appropriate category for these is
‘concessional’ on the basis of them conceding that the
founder of the profession is irrelevant, as are his original
concepts.
My conclusion is that when emotive interpretations
and political agendas are stripped from the litera-
ture, the evidence shows that the professional identity
of chiropractic is skewed with a negative left tail
representing no more than 30% of the profession who
concede Palmer’s founding concepts by abandoning or
modifying his ideas to suit their own agendas, whatever
they may be, and about 70% grouped as conventional
chiropractors in the manner of the founder. Predictive
modeling shows the ‘identity mode’ is firmly gathered
within the conventional majority.
Funding sources and potential conflicts of interest
This research did not receive any specific grant from
funding agencies in the public, commercial, or not-
for-profit sectors. No potential conflict of interest was
reported by the author. The axiologic bias of the author
has been noted.
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