Chiropractic and the Emerging Holistic Paradigm

Dr. Redwood's Talk at National Museum of Health and Medicine
Walter Reed Army Medical Center
May 23, 1993
by Daniel Redwood, D.C.

It's a pleasure to be back in Washington. I practiced here in the DC area my first ten years as a chiropractor, from 1980 to 1989 -- first in Falls Church, across the river, and later at Sixteenth and K Streets in downtown Washington. It's a pleasure to see old friends, and to make new ones.

As far as I have been able to determine, I am the first chiropractor to appear as an invited guest speaker at the National Museum of Health and Medicine. I want to thank Dr. Micozzi, the museum's director, for sending me an invitation, and I also want to thank all the other sponsoring groups, in particular the federal institutions, the National Institutes of Health Office of Alternative Medicine and the United States Botanic Garden, for recognizing the need for a gathering such as this. I also want to thank the National Wellness Coalition.

Chiropractic is 97 years old -- we celebrate the centennial of our born-in-America healing art in 1995 -- and there are many heartening signs that the future need not mirror the less pleasant aspects of the past. I have great hope that this is a new era in fact, not just in rhetoric. I don't know that I'd use the word revolution to describe the changes that are now occurring, but I think it's clear that the holistic health movement, with chiropractic as a part of it, has taken tremendous strides forward in recent years, surpassing even the most optimistic predictions.

Over the years, I've found in many places, including the sometimes rough-and-tumble world of interprofessional and intraprofessional squabbles, that true revolutions make haste slowly. As the great American novelist Jack Kerouac put it, "Walking on water wasn't built in a day." We're in this for the long haul.

And while there may be retrograde forces that at times succeed in temporarily retarding the progress of the holistic health movement -- in certain instances, or in certain countries -- I believe that a critical mass has been reached, and that major positive changes will continue at an accelerating pace.

My talk today is not only about chiropractic, but about an emerging holistic paradigm. This paradigm, as I see it, has two central defining characteristics: first, the focus on wholeness and whole systems; and second, the emphasis on sustainability.

When I speak of an emerging holistic paradigm, it's very important for us to view it in a broad historical context, both in the interests of accuracy, and also to keep us from patting ourselves too much on the collective shoulder, congratulating ourselves for things we did not create.

The holistic health paradigm now emergent in our culture, in Western industrialized nations, draws deep from the wellsprings of cultural knowledge contained in the traditional medicines of China, India, and indigenous peoples throughout the world. We are just beginning, in the West, to reconnect body, mind and spirit. These other cultures never made the separation in the first place. They are holistic in the deepest sense, and their healing systems, perhaps not coincidentally, have proved to have remarkable staying power, surviving thousands of years.

Now I have a question for you. Can you picture contemporary Western medicine lasting for the next few thousand years? Think about it for a moment. (And actually, please think about it later too, for more than a moment.)

Without my knowing your answer, I want to pose another question, which is: If not, why not? These are serious, challenging questions, and they bring us to the second defining characteristic of the emerging paradigm, which is sustainability. The term "sustainable" is one which has achieved widest currency in connection with the environment. We often hear talk, for example, about what is sustainable in terms of the carrying capacity of a particular ecosystem. That is: how much pollution can it endure before it starts to break down?

The best definition I've heard for sustainability is one advanced by Native Americans. They define sustainability by attempting to look seven generations into the future, and then judging whether proposed actions are life-affirming in that long-term context. As we all know first-hand, this is not the way modern industrialized societies, including the United States, usually go about planning for the future. It should be.

It seems to me that in order to define the contents, or at least map the contours, of a holistic health paradigm, we need to ask ourselves what is going to be sustainable for the next several generations. I figure the best place for me to start is to look at my own discipline, chiropractic. I want to speak to you today about my profession-- where it came from, what it is, and what it isn't. In doing so, I am aiming to show that chiropractic:

• is on solid historical footing
• that there is extensive scientific research documentation in its favor
• and that it is both sustainable and worth sustaining.
• Let's begin at the beginning.

Spinal manipulation has existed in one form or another for millennia. There are accounts of manipulative therapies that apparently go as far back as 2700 B.C. in China, and there is a similar legacy from Babylonia to Central America to Tibet.

Hippocrates, a Greek physician born in 460 B.C. was, among many other things, an early practitioner of spinal manipulation. The Hippocratic Corpus, recorded by physician-scholars in Alexandria, Egypt, when that city was the cultural center of western civilization, includes detailed descriptions of manipulative methods.

Galen, a Greek-born Roman physician who lived in the Second Century A.D., and whose approach to healing set the officially recognized standards in western medicine for 1500 years after his death, also utilized spinal manipulation. Galen reported successfully resolving a case of weakness and numbness in a patient's hand, by manipulating the seventh cervical vertebra, at the bottom of the neck.

As Europe endured what would later come to be known as the Dark Ages, these healing traditions were preserved by the ascendant Arabic civilization, in the learning centers of the Middle East. Later, this body of knowledge returned to Europe, and the works of Hippocrates and Galen formed the foundation of Renaissance medicine. Ambroise Paré, one of the great doctors of the Renaissance, sometimes called the Father of Surgery, used manipulation to treat French vineyard workers in the sixteenth century.

During the centuries that followed, up to the beginning of the modern era, methods of manipulation were passed down from generation to generation within families. These practitioners were called "bonesetters," and their methods were transmitted not only from father to son, but very often from mother to daughter. Bonesetting played an important role in the history of alternative healing in Great Britain, and similar methods are common in the folk medicine of many nations.

Birth of the Modern Professions

Now, moving forward a few centuries, closer to the present time . . . In the second half of the nineteenth century, the United States was a crucible of natural healing theory and practice. Two manipulation-based healing arts, chiropractic and osteopathy, trace their origins to that era. Both were born in the Midwest.

Neither of them emerged in a vacuum. In 1843, a medical physician named J. Evans Riadore, wrote in a book entitled Irritation of the Spinal Nerves that "if any organ is deficiently supplied with nervous energy or . . . blood, its functions immediately, and sooner or later its structure, become deranged." Dr. Riadore concluded that irritation of the spinal nerve roots caused diseases; and he advised spinal manipulation to treat this.

Riadore's work predated by a few decades the development of osteopathy by Andrew Taylor Still in the 1870s, and the introduction of chiropractic by Daniel David Palmer in the 1890s. Whether or not Still and Palmer were personally acquainted with Riadore's work, and it seems likely to me that they were, their pioneering efforts certainly occurred in a context where work such as Riadore's was in the public domain. Interestingly, Riadore's statement about deficiency "of nervous energy or blood" summarizes in one phrase the respective founding principles of chiropractic and osteopathy.

Since its beginnings, chiropractic has attributed the central role in health to the nervous system. Osteopathy was founded on what Dr. Still called the Law of the Artery. Osteopaths traditionally asserted that the circulatory system was the key to health.

Both Still and Palmer formulated their hypotheses and built their new professions against a backdrop of medical orthodoxy which they, and others, found to be frequently ineffective and occasionally barbaric. The story of what led Dr. Still to found osteopathy is, to me, one of the great dramatic stories in healing arts history, and while he founded a profession that differs in some respects from mine, it's important to me today to honor not only Dr. Palmer, but Dr. Still as well.

Still's story is not for the faint-hearted. But since we're in a museum today, it seems somehow appropriate to revisit important moments in history. So, I want to ask your forbearance in permitting me one brief chilling tale.

Dr. Still was a Missouri country doctor, who lost three of his children to spinal meningitis. The standard treatment of that era -- this is the unpleasant part -- was cauterization, which involves burning through the skin with a hot iron, followed by the application of leeches to the raw exposed spinal tissues. Still watched his three of his children go through that and then die. Afterward, somewhat like the Job in the Bible, Still cried out in his pain for understanding. He spent the rest of his life developing the natural healing art he called osteopathy.

Chiropractic: Then and Now

Daniel David Palmer was a self-educated man who founded chiropractic on the premise that the vertebral subluxation (which is a form of structural and functional spinal imbalance) was the cause of virtually all disease, and that the chiropractic adjustment (which is a specifically applied manual manipulation) was its cure. This "one cause-one cure" philosophy has played a central role in chiropractic history -- first as a guiding principle, and later as an instructive historical remnant.

Few contemporary chiropractors would now, almost a hundred years later, endorse the "one cause-one cure" philosophy. It nevertheless remains true that the essence of chiropractic is still the detection and correction of spinal subluxations. In modern terminology, a brief definition of a subluxation would include 'the loss of proper spinal joint motion, with consequent aberrant nerve signaling'.

Chiropractors in many cases do more than correct subluxations, but it is our ability to do this one thing well that has allowed us to survive for a century under an incessant barrage of medical opposition; some of it justified, most of it not.

The "one cause-one cure" adherents among the early chiropractors had two major political effects on the development of the profession. First, their deep and sincere belief in the truth of their message, combined with the sometimes stunningly positive results of chiropractic adjustments, created a strong and steadily growing constituency of chiropractic supporters. They forged a grassroots movement, which ensured the survival of the profession through some very stormy years in the first half of the twentieth century.

But at the same time, by sometimes making inflated claims, and failing to back them up with hard evidence, some chiropractors also managed to convince most medical physicians, and through them a substantial portion of the general public, that chiropractors were not to be trusted.

I'm willing to stipulate that not all chiropractors have behaved admirably at all times over the past 100 years. But at the same time, it's important to remember that organized medicine has not exactly been a disinterested party solely seeking to protect the public well-being.

I want to just briefly mention, for those of you who may not be familiar with it, the Wilk versus the American Medical Association et al suit, which went all the way to the United States Supreme Court before being won by the chiropractors in 1990. It brought to light what the trial and appeals court decisions found to be a decades-long pattern of conspiracy and political intrigue, which went so far as to include (and this can be verified in the trial record) rigging a federally mandated study in advance. This particular incident occurred in the early 1970s. Congress had ordered this study to determine whether chiropractic should be included in Medicare. In 1973, despite this behind-the-scenes subversion (I don't know a more accurate word to describe it), chiropractic finally was included in Medicare.

In the Wilk v. AMA decision, the AMA was found guilty of a host of anti-trust violations in relation to its campaign to "contain and eliminate" (those are the AMA's own words from an internal document) the chiropractic profession. The American judicial system sometimes seems to move interminably slowly, but in this case justice finally prevailed.

There's something about being here in Washington that leads me to want to discuss public policy for hours. Maybe it's something in the air or water. I am, however, going to exercise some self-restraint, because I am assuming that many of you came to hear me speak about the healing arts, and not just politics.

Dynamic Equilibrium

Let's all take a deep breath . . . Once more, slowly, in through the nose, and out through the mouth . . . Now, I would like each of you to picture a mobile hanging from a ceiling. The mobile has many strings hanging down, and on these strings are suspended small pieces of beautiful pink and blue glass. It's not moving. It's in a state of dynamic equilibrium. Picture the mobile.

What is dynamic equilibrium? Perhaps the best way to start to understand it is to picture what happens when it is disrupted. Now, please cut one of the strings on your mobile, with your invisible scissors.

What happens? Assuming that you are on Planet Earth and are therefore still subject to the laws of gravity as we know them, the whole mobile starts moving and shifting and jangling around. It has lost its old equilibrium. If it's a wind-chime, it may sound quite melodious. Eventually, it slows down and gradually comes to a stop, in a new state of dynamic equilibrium.

But things have changed. It doesn't look the same. All those pretty pieces of glass have shifted, in relation to the central axis and also in relation to each other.

This image was first described to me just a few months ago, and as you can see it really caught my fancy. I heard it from Dr. Jerry McAndrews, a chiropractor who is a former president of Palmer College of Chiropractic, my alma mater, and now serves as Vice President for Professional Affairs of the American Chiropractic Association.

His point, of course, is that the human body, and in particular its musculoskeletal system, is in certain respects quite similar to the mobile. When an injury occurs in one area, and normal balance is disrupted, the body must make compensations. Structural patterns will be altered to a greater or lesser degree, depending on the nature and intensity of the forces that threw off the old equilibrium.

Let's take an example. Let's say there's a child who moderately injures his or her back playing ball at age ten. If chiropractic care is sought early, relatively little treatment may be required, because these compensations will not have had time to deeply embed themselves structurally. The child might need just one or two adjustments. But if that child waits until age 35 before seeking chiropractic care (not an uncommon occurrence), the situation may prove far more complex. Patterns of long-term muscular rigidity and asymmetry, calcium deposits in ligaments, and subtle or gross structural shifts of the vertebral column or ribcage may set in with some real staying power.

That is why a chiropractor, or an osteopath, cannot be expected to clear all conditions with one or two treatments. Chronicity is a great challenge in all branches of the healing arts. It is also something that is extremely difficult to generalize about, because the pattern of compensation in Patient A may differ markedly from the pattern of compensation in Patient B.

Foundations of the Chiropractic Model

This brings us to the question of how chiropractors evaluate the body. While each chiropractor develops her or his own preferred style, there are areas of common ground, and common outlook, which are shared by nearly all chiropractors.

From Dr. Palmer onward, chiropractors have purposely refrained from assuming that the site of a symptom is the site of its cause. This is a crucial part of the chiropractic diagnostic model. Our training as chiropractors leads us to assume, instead, that the site of the cause should be looked for somewhere along the path of the nerves leading to and from the site of the symptoms. This is a corollary to Palmer's basic principle which holds that the nervous system is of primary importance.

Most people who come to chiropractors are experiencing physical pain. In evaluating this pain, we look for the cause, recognizing that it may or may not be at the site of the pain. A pain in the knee might come from the knee itself, but if we trace the nerve pathways between the knee and the spine, we find along the way possible areas of causation:

• in or around the hip,
• in the deep muscles of the buttocks or pelvis,
• in the sacroiliac joints,
• or in the lower back.

Furthermore, if an imbalance does in fact exist in the lower back (say, at the fourth lumbar level, near the waist), it might have its source at the fourth lumbar, or that might possibly, in turn, be a compensation for another spinal joint dysfunction or subluxation elsewhere in the spine, perhaps in the mid-back or the neck. (The plot thickens). For these reasons, an integrated, whole-body approach to structure and function is of great value.

In my experience, orthodox medical physicians dealing with musculoskeletal problems far more frequently than chiropractors make the assumption that the location of a pain is the primary location of its cause. Thus, knee pain is generally assumed to be a knee problem, shoulder pain is assumed to be a shoulder problem, and so on. I recognize that there are many exceptions to this generalization, but I believe that on balance, it's true. This pain-centered diagnostic logic frequently leads in the right direction, but sometimes it leads in the wrong direction.

It often leads to increasingly sophisticated and invasive diagnostic and therapeutic procedures. If the physical exam of the knee fails to clearly define the problem, then the knee is x-rayed. If the x-ray fails to offer adequate clarification, then an MRI or other advanced imagery method is performed. Increasingly invasive procedures, sometimes including surgery, may be utilized.

Chiropractors also utilize the diagnostic tools I've mentioned, and we sometimes refer patients to surgeons. My point is not to criticize x-ray, MRI, or surgery, when truly needed. My purpose is advocate an alternative diagnostic and therapeutic model, that is less invasive, and encourages the body's inherent capacity for restoring balance.

Whole-Body Context

I have seen more than a few cases of knee trouble where the entire scenario we just went through was played out, and the cause of the problem turned out to be in the lower back. If someone's lower back is mechanically dysfunctional, and in need of spinal manipulation, this can often place unusual stress on one or both knees. In cases of this sort, you can spend months or even years medicating the knee symptoms with painkillers or even steroids, not to mention possible knee surgery, without ever addressing the real problem. This is not an isolated hypothetical instance. It happens far too often.

The chiropractic approach to musculoskeletal pain encourages evaluation of the site of pain in a whole-body context. Shoulder, elbow and wrist problems can have their source in the shoulder, elbow and wrist -- but pain in all of these joints often has its source in the neck.

Similarly, pain in the hip, knee, and ankle can also have its source at the site of the pain -- but in many cases the source lies in the lower back. The need to consider this chain of causation is built into the core of chiropractic training. I believe that practitioners of all health professions would benefit from adding this perspective to their professional worldview.

The chiropractic model falls well within the holistic continuum. It pays heed to patients' nutritional needs, exercise habits, work conditions, and psychological health. In many cases, particularly with regard to nutrition and exercise, the chiropractor will act as a teacher, directly counseling patients on proper diet or exercise methods. In other instances, chiropractors make referrals to other health practitioners, or to appropriate classes in the community. For example, I often teach my patients meditation or relaxation methods, and encourage them to attend yoga classes.

The traditional chiropractic philosophy I learned during my training 15 years ago anticipated in many respects the concepts that comprise the modern wellness model. Aside from being taught the importance of good diet, exercise, and emotional health, we also learned in school that it is far better to practice prevention than to engage in crisis-care, and that health is far more than the absence of symptoms. These ideas together form a respectable foundation for any profession that seeks to practice holism.

The Current Status of Chiropractic

I noticed that the first word in the title of this conference is "alternative." Depending on how you define this term -- and there are real differences of opinion within my profession about this -- chiropractic is arguably the largest of the alternative healing arts in the United States. Close to 20 million Americans are treated by our nation's 45,000 chiropractors each year, double the number of patients of a decade ago.

I think I've heard it said in more than one political context that "20 million Americans can't be wrong." But numbers alone are not necessarily an adequate answer to the question: Is chiropractic effective?

It's a reasonable question, and I want to say to the chiropractors who are here today that it is very important for us to remember that the fact that someone asks this question, does not necessarily mean that they wish us ill. It means that they want us to show them, rather than tell them.

For those of you who are not chiropractors, I want to go over, briefly, the most important research of the last several years. I have mentioned that there is a good deal of recent research validating chiropractic treatment for musculoskeletal problems. But because most of these studies are recent (within the last decade), many people don't know that they exist. Time does not permit me to discuss all of them.

I want to at least cover what I think are the highlights.

Canadian Study

In 1985, a landmark study was published in Canadian Family Physician which researched the effects of chiropractic adjustments for people with severe and chronic lower back pain. The more than 300 subjects in this study had been "totally disabled" by back pain for an average of seven years, and had gone through the full gamut of standard medical interventions.

The data from this study showed that after three weeks of daily chiropractic adjustments, between 79 and 93 percent of those patients (excluding for the moment those people with spinal stenosis, which is a narrowed spinal cord), between 79 and 93 percent had good to excellent results, reporting substantially decreased pain and increased mobility.

Even among those with a congenitally or developmentally narrowed spinal cord, a significant minority showed substantial improvement.

Remember now, every single one of these people had gone through extensive, unsuccessful medical treatment at a Canadian university hospital orthopedics department, prior to being allowed to participate as a research subject. Follow-up a year later demonstrated that the changes were long-lasting.

These results are remarkable, but what was extraordinary about the Canadian study was the fact that it was jointly administered, and the journal articles jointly authored, by Dr. J.R. Cassidy, a chiropractor, and Dr. W.H. Kirkaldy-Willis, a world-renowned orthopedic surgeon. The study was published in 1985. In early 1993, Dr. Cassidy became the first chiropractor to be named research director of a university orthopedics department. It's in Canada, at the University of Saskatchewan in Saskatoon.

British Study

In 1990, the British Medical Journal published an article, "Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment." It's by a medical physician, Dr. M.T. Meade. Meade's research compared chiropractic manipulation with standard hospital outpatient treatment for lower back pain. The medical treatment consisted of wearing a corset and seeing a physical therapist.

Meade's conclusion was as follows:

"Our trial showed that chiropractic is a very effective treatment, more effective than conventional hospital out-patient treatment for low-back pain. One of the unexpected findings was that the treatment difference -- the benefit of chiropractic over hospital treatment -- actually persists for the whole of that three-year period [of the study] . . . it looks as though the treatment that the chiropractors give does something that results in a very long-term benefit."

The great significance of the Meade study is that it is the first randomized study to demonstrate long-term benefits from chiropractic care. One baseless, but persistent, criticism of chiropractic has been that while it may offer short-term relief (and even that is a very recent concession on the part of our critics), chiropractic is of no lasting value. The Canadian and British studies, taken together, should lead reasonable people to realize the inaccuracy of this claim.

Dutch Study

The final example I want to mention is a study from the Netherlands, also published in the British Medical Journal, in 1992.

It compared and contrasted lower back pain patients treated with mainstream physical therapy methods with those treated by chiropractic manipulation, and it also compared these two methods to placebo treatment and to standard medical treatment by a general practitioner. This is a very interesting analytic protocol, unlike anything I've seen applied to manipulation previously, and probably a harbinger of creative thinking yet to come.

The results showed that both the chiropractic adjustments and the physical therapists' treatments were significantly more effective than a placebo and significantly more effective than treatment by a general practitioner. In addition, those receiving chiropractic manipulation showed more improvement than the physical therapy patients, in fewer visits.

Within the past year, American primary care physicians, largely as a result of the convincing nature of all of these studies, have begun to make serious, and I believe sincere, moves in the direction of reversing a longstanding anti-chiropractic bias, which has historically been inculcated in medical schools.

The most startling development was the publication in the November 1992 Journal of Family Practice, of three articles endorsing chiropractic care. They said that primary care physicians should re-evaluate their opposition to chiropractic, and set up mechanisms to refer patients to chiropractors.

One other recent study showed that more than half of the primary care physicians in the state of Washington refer patients to chiropractors for treatment of musculoskeletal conditions. My own guess is that the figure is lower in Virginia, where I practice, but, as Bob Dylan once wrote, "the wheel still it spins," and "the times are a changing."

It may take some time for this shift to fully take hold, but I think I can say without much likelihood of being incorrect, that these recent developments portend a major realignment of interprofessional relations in the coming years.

Chiropractic and Internal Organ Disorders

The vast majority of chiropractic patients arrive seeking help for musculoskeletal problems like back pain, neck pain, and headaches. But spinal adjustments can also have positive effects on other organs and systems. Though our therapeutic interventions are in large measure focused on the spine, we see this as a means of accessing the whole body, via the nervous system. While chiropractic adjustments are directed to restoring motion at specific vertebral joints, the effects of these adjustments extend beyond the local area where the adjustive force is applied. Effects extend to all structures served by the nerves originating in the spine.

In the book that I've just finished writing, I go into several case histories from my practice which illustrate this. I have personally seen chiropractic adjustments have profoundly positive effects on conditions involving the:

• the digestive tract,
• the urinary tract,
• the female reproductive system,
• and the respiratory system.

My Most Unusual Case

I want to tell you a story which I consider to be my most unusual case. It happened my first year in practice. A young man I'll call George came to me after having been in a motorcycle accident a year earlier. He had been thrown 30 feet through the air, and was lucky to have survived. He was in a lot of pain at the beginning, but after a month or so in the hospital effectively put him back together, he was pain-free.

However, he had one symptom that wouldn't go away. He was constantly nauseous. He had been to all sorts of medical physicians -- from internists to neurologists to psychiatrists, and he had also fasted -- all in an effort to get to the root of the problem. He was referred to me by a medical doctor who specialized in homeopathy, a holistic doctor in my community who was knowledgeable enough to suspect that chiropractic might be able to help.

To make a long story short, I found that George's nausea was worst when he ate protein foods, and I found a subluxation in his upper neck. I referred him for x-rays, to be certain that there were no dangerous contraindications to manipulation. When I confirmed that there weren't, I adjusted his neck, and I asked him to pick up some hydrochloric acid tablets at the local health food store, since hydrochloric acid is what the body uses to break down protein in the stomach. I figured I'd cover all my bases.

He came back the next day, and he was ecstatic. The nausea was gone. Though I would respond differently today, back then my first response was to assume that the hydrochloric acid tablets had worked. But it turned out he had gotten lost on the way to the health food store, and never got the tablets. So, I asked what he had eaten the day before, wondering whether some new dietary change had had a therapeutic effect.

He looked at me and said, somewhat sheepishly, that his entire dietary intake the day before had consisted of ice cream, pecans, and beer, and that that was not at all that unusual for him. Drawing on the accumulated wisdom of my one year in practice, I reached the professional opinion that these were unlikely therapeutic agents.

It finally dawned on me, beginner chiropractor that I was, that I had narrowed things down to the point where there was only one explanation left. The upper cervical chiropractic adjustment had done it! His nausea never came back in the three years we stayed in touch. I also want to add that I later spoke to him at length about diet, and he eventually made major changes for the better.

I learned a lot from George's case. Most of all, I learned not to underestimate the effects of spinal manipulation on internal organ function. The results are not anywhere near as predictable as they are for lower back pain, and the research base in this area still is quite sparse. But these cases do exist, and for people whose internal organ problems are caused by spinal subluxations, nothing else is likely to help. George could have spent 50 years being nauseous. Think about it! And the next time someone says chiropractic is only good for back pain, please remember George.

• Neck adjustments, like the one I gave George, can affect not only the neck and arms, but also the function of various organs in the head (via sympathetic pathways), and in the chest and upper abdomen (via the parasympathetic vagus nerve).
• Upper back adjustments affect nerves which directly supply not only the upper back, but also the lungs, the heart, and parts of the digestive tract.
• Adjustments of the lower back may influence not only the lower back and legs, but also the kidneys, pelvic organs and lower digestive tract.

The reason relatively little in-depth chiropractic research has been done on internal organ problems is that the chiropractic profession has had to prioritize the research it could afford to pursue in the absence of significant government funding.

I am acutely aware today that I am speaking on the grounds of the Walter Reed Army Medical Center, at a forum sponsored by a branch of the National Institutes of Health, at a time when it is still true that only a minuscule amount of United States government funding goes to chiropractic research. As you heard earlier, nearly all the landmark studies have taken place outside the United States.

Serious studies are expensive, often running into the hundreds of thousands of dollars for multi-year clinical trials with followup. Proving the validity of spinal manipulation for those conditions most commonly treated by chiropractors (lower back pain, neck pain, and headaches) has understandably been the profession's highest research priority.

Most, if not all, chiropractors, however, would agree that they have seen cases where internal organ problems have responded to chiropractic adjustments. A major study has just been funded which will track the effects of chiropractic care for women with dysmenorrhea (that's painful menstruation), a very common condition in our society. This is a $600,000 project. Published preliminary findings in peer-reviewed scientific journals were quite positive, and the larger study is scheduled to be completed in 1996.

The First Chiropractic Adjustment

There's one more story of chiropractic affecting internal organs which I want to share with you. It's the story of Daniel David Palmer's first chiropractic adjustment, in 1895. This is another one of those dramatic moments in healing arts history.

Harvey Lillard, a deaf janitor in the building where Palmer had an office, came to Palmer for help. Palmer gave him a spinal adjustment, which is believed to have been somewhere in the vicinity of the upper thoracic vertebrae, in the upper back, after which Mr. Lillard was able to hear for the first time in many years.

At first, it appeared that Palmer might have discovered a cure for deafness, but similar results were not forthcoming when other deaf people heard about Harvey Lillard, and sought Palmer's help. There have been other instances through the years of hearing restored through spinal manipulation, including one by Canadian orthopedist J.F. Bourdillion, M.D. But these have been very rare, and no predictable pattern has ever emerged.

The story of Lillard's recovery has been used for many years to disparage chiropractic, with repeated charges by the naysayers (primarily anti-chiropractic MDs) that such an event is impossible, because no spinal nerves supply the ear. A couple of years ago, I was testifying as an expert witness in a patient's automobile accident case, and the opposing attorney, his voice dripping with sarcasm, attacked me with this very story.

It's important to refute the charges specifically. The underlying physiological mechanism is called the somato-autonomic reflex, fully recognized in all modern medical and chiropractic textbooks. Its name describes the interaction between the musculoskeletal system (that's where the 'somato-' part of the term comes from), and the autonomic (or involuntary) pathways of the nervous system. So it's a somato-autonomic reflex.

Signals initiated by spinal manipulation are transmitted via autonomic pathways to internal organs. In the case of Palmer's first adjustment, the relevant nerve pathway starts in the upper back, coursing up through the neck and into the skull, along sympathetic nerves which eventually lead to the blood vessels in the ear. Proper functioning of the hearing apparatus depends on a normal blood supply, which in turn depends on an adequate nerve supply. While it is true, in the technical sense, that there are no spinal nerves directly supplying the ear, it is absolutely untrue that no nerve pathway links the two areas. Anatomists have long ago verified that these pathways exist, and any claims to the contrary betray ignorance of fully accepted modern physiology research.

Just as there are autonomic pathways supplying the ear, similar pathways lead from the spine to all parts of the body. In the modern era, the work of Czech neurologist Karel Lewit and others has been particularly helpful in spreading these concepts beyond the chiropractic community. Dr. Lewit has for many years successfully used spinal manipulation to treat tonsillitis, breathing problems, migraine, vertigo, and much more. This is an M.D. neurologist in the Czech Republic.

I said at the beginning of my talk I wanted to show three things about chiropractic:

• that it is on solid historical footing,
• that there is good scientific research supporting it
• and that it qualifies as sustainable.

So far, I've focused on the first two. If you want to follow up further on the research or the history, I want to recommend a book by a former president of the British Chiropractors Association, Dr. Michael Copland-Griffiths. The book is called Dynamic Chiropractic Today, published by Thorsons in Britain and Harper Collins in the United States. Or, if you can wait, until later this year, my book A Time to Heal , should be out by January.

Sustainability

So, we've looked at history and research. What about the third point, sustainability?

The essence of chiropractic is the hands-on chiropractic adjustment or manipulation, which is completely sustainable. The chiropractic adjustment is at home in both high-tech and low-tech settings. Spinal manipulation has already lasted for thousands of years, and I expect that it will last long into the future. It is a pure, person-to-person interchange, which may utilize various tools, but requires few, if any. The fundamental tools of chiropractic are the hands, heart and mind of the doctor.

I think that, in general, those methods most dependent on high-tech equipment will prove least sustainable in the long-run. (And when I talk about the long-run, remember, I'm talking about hundreds of years). While contemporary chiropractors, myself included, do avail ourselves of some high-tech diagnostic (and in some cases therapeutic) methods, these are secondary, not the essence of the art. The essence is the hands-on adjustment.

I am not going to use this occasion to go into a lengthy discussion of sustainability. I've given a general definition and pointed out where I think chiropractic fits on the spectrum of sustainability. I do want to say that this is a question we need to explore in greater depth in the coming years. This landmark conference marks the first time, to my knowedge, that the issue of sustainability in health care has been placed on the table in a respectable public forum. Actually, I hesitate to even use the word "issue," in relation to sustainability, because in a town like Washington that tends to pigeonhole it in relation to many other legitimate, high-priority, health issues.

Sustainability is more than an issue. Sustainability is about a fundamental paradigm shift and realignment. The question is, are we willing to use sustainability as a central organizing principle for developing the health care systems of the future?

In his book, Earth in the Balance, Vice President Gore made the case for using sustainability as the central organizing principle with regard to the environment. I think it's now incumbent upon us to make the case for using sustainability as a guiding principle for future decisions about the ways we as a society go about trying to keep ourselves healthy.