JR Carter Commentary Subluxation – the silent killer and integrity to maximize these opportunities. It appears that a small segment of our profession, with some elected leaders, appear intent on answering this crisis with only the 1910 chiropractic subluxation model. Their approach is not only wrong, but it prevents what is right from being done. Dr. Darrel Ladell stated it so well in his report on the Radiology Issue: Beware of the enemy for he is us. Subluxation, though a vital part of our history has been described as the Achilles Heel of our profession. When you review the available literature and combine it with knowledge of our history, it quickly shows where the subluxation model has failed. This model has cost us years of positive growth. This paper proposes that there is no need to beat our profession up again, punishing us with a misdirected alle- giance to our dysfunctional history. There is a positive path to follow that will assure the acceptance of the pa- tients we treat, increase the public enhancement we seek and provide a greater acceptance into the scientific health care delivery system. Working together in partnerships and further develop- ing our expertise as the leaders in the area of manipulation will assure our future. As leaders in the complementary Ronald Carter, DC, MA* health care system, our profession will see greater num- Past President, bers of the public and provide us greater opportunity to Canadian Chiropractic Association serve. The demands for success are not beyond what we can achieve collectively. Those who are sincere and choose a future of service and security will be anxious to read this document. Those who refuse this information Introduction may well become the true victims of the silent killer. Chiropractors in Canada are facing a crisis and responding to it. With any crisis come opportunities. These crises are “You did what you knew how to do, challenging our core issues collectively as a profession. It and when you knew better, you did better”1 will require the utmost effort and commitment to honesty The task of preparing this paper came only after consider- able reflection, contemplation and a substantial invest- ment in research time. Despite the temptation to remain * Private practice. #222 – 1632 14 Avenue NW, Calgary, Alberta T2N 1M7. mute and allow apathy to overcome good conscience, email: [email protected] there was a vigor and persistence to present an alternative J Can Chiropr Assoc 2000; 44(1) 9 Commentary position to the too often proposed dogmatic subluxation doctors of chiropractic the privilege of clinical practice. model. Society grants this privilege to doctors in the interest of the Practicing chiropractic has provided me a multitude of public’s and patients’ welfare.4 special opportunities to serve the profession at every gov- Dr. Joseph Janse was one of our profession’s greatest erning level. I am most grateful for these opportunities and leaders and left us with a legacy of wisdom. His words will to have been a small part of this dynamic family. It is now hopefully be an example to all of us in how we should my time to pay some of my dues for those privileges and conduct our affairs on this occasion. Frequently I am become vocal, to share what wisdom has been given to me humbled by the great work and duty that confronts us, and in the past and to provide an additional window from in this attitude of humility I find myself compelled to ask which to view ourselves today. the question: Isn’t the promise of our future worth every Many believe our professional future, in many ways, is endeavor and sacrifice that we may be called on to make; nearing a crisis. There can be a very positive benefit to isn’t it our duty to set aside all differences of the past and to crisis: “Unless a crisis actually kills us, (often it just feels de-emphasize all misunderstanding and in broad minded like it will), it is an opportunity for us to change. It’s a tolerance work together? chance for us to choose a new path. There are two kinds of We are all concerned as to the future of chiropractic. people – those who are changing and those who are setting We all wish the very best for our profession. In this respect, themselves up to be victims of change.”2 I am no different than you. Certainly you are no less Our collective choices, more than chance, determines sincere than I in the desire to affect our professional our circumstances and future. Today, the molding of the security and certainly I am no more qualified to speak and future of chiropractic in parts of Canada is being shaped by act on this subject than you. Hence, an exchange of ideas some elected members and volunteers who appear to have should be a matter of mutual benefit. In this spirit of mutual an obsession with only the subluxation model of chiro- respect, may I humbly set forth a number of ideas that I practic while being blinded to the many other very positive sustain in relationship to the future of our profession.5 options. To challenge this philosophical position one Dr. Janse continued this address with ten necessities for should review the wealth of evidence from our past that professional maturity. I suggest the tenth necessity is most indicates this model is not only ineffective but, at times, fitting in this discussion. “I recommend that we daily re- has been extremely damaging to the profession. Subluxa- emphasize the great privilege that is ours. It is a privilege tion, unfortunately with a great deal of truth, has been to be a doctor; it likewise entails great responsibilities. referred to as the “Achilles Heel” of chiropractic. The greatest adventuring in doctoring is one of the most This chiropractor believes by integrating ourselves laudable of all human endeavors, and we should be grate- within the system rather than out of it and by placing the ful for our opportunities. Let us be people who possess a patients’ interests first the profession will mature posi- high threshold of moral and emotional competence. Let us tively. “The future is not some place we are going, but one grace society with an influence of gentility that will com- we are creating. The paths to it are not found but made, mand their respect and admiration. We are doctors of and the activity of making them changes both the maker chiropractic; men and women dedicated to the privilege, and the destination.”3 the responsibility and the task of being wardens of a Who does chiropractic belong to? To chiropractors? To profession. Within our reach is the immortality of great- the professional associations (ACA, ICA, FSCO, etc.)? ness; within our power is the destiny of great principle. What about D.D. Palmer and his descendants; does the This is a realization that should be ours.”6 Palmer family own chiropractic? Do state licensing If we do not own chiropractic and are entrusted to be boards own chiropractic? What about colleges and their wardens then we are required to become leaders in chiro- leaders ... does the science and art exist for their benefit? I practic. “What we have discovered and rediscovered is think not. Chiropractic belongs first and foremost, to pa- that leadership isn’t the private reserve of a few charis- tients. The science and art belongs to all people, but most matic men and women. It’s a process ordinary people use importantly to the sick and ailing who may benefit from it. when they’re bringing forth the best from themselves and This is why societies, by way of their legislatures, grant to others. Liberate the leader in everyone and extraordinary 10 J Can Chiropr Assoc 2000; 44(1) JR Carter things happen.”7 child until legal clothing could be secured.”11 If you truly want change and you truly acknowledge that “In the long run, it makes little sense to us that a you create your own experience, then you must analyze profession, especially one that promotes itself as “scien- what you’ve done or haven’t done to create the undesir- tific,” would continue to devote so much of its mental able results. If you don’t accept accountability, you will energy and resources aggressively involved in concocting misdiagnose every problem you have. If you misdiagnose, theories to explain how a given therapy might have been you mistreat. If you mistreat, things won’t get better, plain responsible for any of a whole host of seemingly “miracu- and simple.8 Accountable chiropractors diagnose contrary lous” clinical outcomes without first adequately demon- to those who profess to be “straight chiropractors”. We strating whether its’ therapies had anything whatsoever to should become experts at diagnosing the health of our do with them!”12 profession. There are chiropractors that find diagnosis and “The fact that such treatment claims are all too often being a doctor stressful. To them these issues gives rise to based on clinical observations involving conditions al- uncertainty as to their role and responsibilities. It becomes ready known to exhibit extremely high rates of natural a confusing issue for them. Jesus, who for many is consid- remission merely adds insults to injury. At least, both ered the greatest healer said: “It is not the healthy who ethical as well as intellectual balance would be required need a doctor, but the sick”.9 D.D. Palmer’s intention for that an equivalent amount of mental energy be devoted to chiropractic was to treat the sick.