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Chiropractic Journal of Australia : CJA March 2013
Chiropractic Journal of Australia Volume 43 Number 1 March 2013 33 To the Editor: RE: Eaton, S. Commentary: The Double Edged Sword of Chiropractic Semantics. Chiropr J Aust; 2012; 42:141-2. Dr Eaton in her commentary on the use of language within the chiropractic profession certainly brings a unique perspective and insight into the problems and challenges facing chiropractors in communicating their ideas and concepts to new students, patients and the wider scientifc community. Dr Eaton clearly points out the problems associated with static ideas refected in many of our defnitions and descriptions of what chiropractic ‘Is’. Problems associated with the use of historical terms by chiropractors are exemplified in the concept of the ‘vertebral subluxation.’ Dr Ebrall in a previous commentary,1 "Subluxation: What's in a Name?" states that the term subluxation has multiple meanings, and causes endless angst. It could be suggested from an historical perspective that the problems commented on by Drs Eaton and Ebrall are not related to semantics or the lack of application of evidence based practice guidelines by the profession. In respect to these two factors chiropractors would appear no different to other contemporary healthcare professions. Rather than the chiropractic profession being "static and incongruent with evidence based enquiry" it could be argued that it is static and incongruent with philosophical and scientifc enquiry. Dr Eaton embraces both of these disciplines with the observation that "chiropractors who are reluctant to think of subluxation as a 'hypothesis' demonstrate a limited understanding of the signifcance of our epistemology.” The hypothesis is the foundation of scientifc enquiry and epistemology is a branch of philosophy. However, from an ontological perspective,2 another branch of philosophy that deals with the nature of reality or being, subluxations do not, and cannot exist. They are not a hypothesis as suggested by Dr Eaton, and their existence cannot be confrmed or disproved by scientifc enquiry. They only exist by defnition as an arbitrary collection or group of things that do exist. The medical defnition of a subluxation is not hypothetical, it is defned as a quantifable entity with the following characteristics:3 (1) a localized kyphotic angulation at the level of injury (2) anterior rotation, or displacement, of the subluxed vertebra (3) anterior narrowing and posterior widening of the disc space (4) widening of the space between the subluxed vertebral body and the subjacent articular masses (5) displacement of the inferior articulating facets of the subluxed vertebra with respect to their contiguous subjacent facets; and (6) widening of the interspinous space ("fanning") Letters to the Editor Scientifc enquiry, with the formulation of hypotheses, can commence once the definition of a subluxation is formulated as a quantifable entity and accepted by the profession. The scientifc questions that then need to be addressed by chiropractors do not relate to the existence of subluxations, but to the clinical utility of such an ontological construct. Chiropractic philosophy provides the rationale for the defnition and is not reciprocal with science. Science generally reciprocates with dogmatically held beliefs. The role of science is to provide reliable and valid measurements relating to the elements the chiropractic profession chooses to include in the defnition of a vertebral subluxation. Evidence based practice can then be used as a clinical tool in "actively seeking support for and improvement of chiropractic clinical practice through the integration of the best available research evidence, combined with clinical expertise and patient preferences.”4 "Ontological and epistemological positions are often not spelled out in research papers. They may not need to be spelled out, but need to be understood since they are at the basis of what is done, of the methods used."5 Scientifc credibility for chiropractic will come not with semantic changes but with the ability of the profession to measure the independent variables (subluxations) that it directly attempts to infuence and the dependant variables (health and wellbeing) that emerge as a result of that intervention. The concept of a subluxation and the defnition used by the chiropractic profession at any given time can be as dynamic as needs and evidence dictate. The terms used by chiropractors may be a double edged sword as long as they are not Excalibur and set in stone. John Dulhunty DC, MACC REFERENCES 1. Ebrall, P. Commentary: Subluxation, What’s in a Name? Chiropr J Aust;41:110-2. 2. http://encyclopedia2.thefreedictionary.com/ontology 3. Green, J D. Harle, T S. Harris, Jr J H. Anterior subluxation of the cervical spine: hyperfexion sprain. AJNR Am J Neuroradiol 1981; 2: 243-50. 4. Haneline, M A. Primer on Evidence-Based Practice for Chiropractors. Chiropr J Aust 2011; 41: 78-80. 5. http://en.wikiversity.org/wiki/Qualitative_research. To the Editor: RE: Eaton, S. Commentary: The Double Edged Sword of Chiropractic Semantics. Chiropr J Aust; 2012; 42:141-2. I fnd this commentary unclear, as it lacks concrete details. It states that 'The Skeptic Organisation and the 'Friends of Science’ (FOS) are highly active in Australia. On two occasions ... the University Executive has asked me to change the name of the discipline or the word "Chiropractic" to “manual” or “physical” therapies.’ FOS address climate science, not chiropractic.1 Does it mean the 'Friends of
CJA December 2012
CJA June 2013