THE SCIENCE OF IDENTIFYING PROFESSIONS AS APPLIED TO CHIROPRACTIC

THE SCIENCE OF IDENTIFYING PROFESSIONS AS APPLIED TO CHIROPRACTIC

IDENTIFYING PROFESSIONS GELARDI THE SCIENCE OF IDENTIFYING PROFESSIONS AS APPLIED TO CHIROPRACTIC THOMAS A. GELARDI, DC' President, Sherman College ...

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IDENTIFYING PROFESSIONS GELARDI

THE SCIENCE OF IDENTIFYING PROFESSIONS AS APPLIED TO CHIROPRACTIC THOMAS A. GELARDI, DC'

President, Sherman College of Straight Chiropractic

1. Sherman College of Straight Chiropractic

Submit correspondenceand requests for reprints to: Thomas A. Gelardi, DC President Sherman College of Straight Chiropractic 2020 Springfield Road P.O.Box 1452 Spartanburg,SC 29304

and depresses morale. The various publics and the legislatures are confused as to the nature of the profession and its needs, and are reluctant to be involved with it. These negative consequences are multiplied by the constant intra-professionalbickering and failure Reinhold Niebuhr to address the problem in a mature and Introduction: The chiropractic profes- effective manner. Both sides use their counterparts as convenient whipsion possesses a valuable and much ping boys for their own shortcomneeded service, and it is toward useful ings in leadership. The leadership services that members of society gravion both sides, in their efforts to tate. People inherently want to be enhanced, and they embrace that which build a following and call it to action, often rely on instilling fear they perceive serves this need. I of the other side to get the job believe both schools of thought within chiropractic serve the needs of people. done. Each side blames the other for the division and for lack of any Both offer services that are relatively substantial professional progress. effective, safe, inexpensive and, in many places in the world, convenient. There is a need for leadership that can

od grant me the courage to change the things I can change, the serenity to accept the things I cannot change and the wisdom to know the dzrerence.

While chiropractic has the inherent attributes of greatness, that greatness has not been achieved. Chiropractic has a problem which severely impairs its advancement scientifically, politically and among those who could benefit from its services. This impairment continually comes between the profession and opportunity, and it facilitates other professions encroaching upon chiropractic's turf.

achieve a resolution or an accommodation reflective of the importance of our profession. The issue is not one of right v. wrong, where one side is likely to see-the-light,give up or be defeated. If the solution does not come from within the profession, it will come from outside forces. If it does not come from the highest principles, it probably will not come at all, and the wolves at the door will feast.

It is well recognized, within and without the profession, that a division exists in chiropractic at a very vital level. The division, and more importantly, the profession's response to it, is its greatest impediment to progress. This division is costly beyond imagination, replacing the AMA as the profession's number one problem. It diverts scarce resources

There are certain risks in dealing honestly with this subject. First, there is a tendency to believe that problems left unrecognized or undisturbed will resolve themselves. Second, popularity contests are not won by discussing problems and recommending solutions that might seem painful.

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If the problem of division is

amenable to any degree of selfresolution, or if an accommodation is to be achieved, leadership must set a climate in which that resolution or accommodationcan take place. The leadership must stop motivating through fear and begin, through word and example, to engender a spirit of courage, communication and cooperation. Job satisfactionand high morale for members of the profession require that the journey be as important as the destination. I have more confidence in my assessment of the problem than in my ability to recommend a specific resolution. If

‘7f the problem of

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division is amenable to any degree of sewresolution, or ifan accommodation is to be achieved, leadership must set a climate in which that resolution or acmmmodatim can take place.”

my assessment is correct, that would be a contribution, for a problem defined is a problem half resolved. Of paramount importance to under-

standing the problem is the need to disabuse ourselves of the popular notion that the source of the division is philosophy, and to a lesser degree, science and art. I hope to show that they are not the proximate cause of the division and that our attention should be directed elsewhere.

Philosophy It seems that most members of both sides of the profession view philosophy

Man innately wants to survive and prosper. Very early in life he learns that his reality involves forces outside of himself that act upon him, and for better or worse, affect his condition. He learns that it is among the forces of the universe that one must continually strive to stay whole. He learns that his ability to successfully control or negotiate the things of reality depends upon his knowledge of their nature. This study, of the fundamental nature of reality, is called philosophy. All consciouspersons have a philosophy, whether they know it or not. Their only choice is the degree of examination that they will give to it. The more valid one’s understanding of reality, the better one can negotiate his continued existence. A valid philosophy, which means a Blaming the division on philosophy valid understanding of the fundamental results from a failure to understand nature of reality, is crucial for choosing the nature of philosophy, and appropriate, self-enhancingvalues dooms to failure any attempt to find and actions. a solution. Chiropractic is a young proMan has an innate curiosity about the fession. It is therefore understandable, nature of reality and constantly attempts according to Maslow’s hierarchy of needs, that an in-depth study and appre- to re-arrange its elements into his perception of more useful, life sustaining, ciation of this investigative method enhancing forms. Through his five should be left, in large measure, for senses, rational mind, and all available today. Many things, i.e., practice buildinformation, including that from ing techniques, the ritualistic repeating science, man consciously and/or of catchy slogans and dogma, pep subconsciously forms his philosophy. rallies, medicine bashing and patient Through science he examines that which testimonials, have been erroneously labeled philosophy, and this has caused is unique to each thing and through philosophy he examines that which is many to mistakenly reject philosophy. common to all things. Through science Philosophy - What is it? he seeks predictabilitywhen one or a Man acts, but before he acts, he thinks. few forces act upon rather static situaHis thoughts are always to gain value, tions, and through philosophy he seeks the ultimate value being life itself. Life predictabilitywhen many forces interact and the sustaining of life are innately in highly dynamic situations. man’s highest goal and the goal to Because philosophy offers predictability which he invests all his time, intellior a common denominator in highly gence and effort. The sustaining and complex areas, areas where science enhancing of life is the standard by cannot function, it is an essential feawhich man consciouslyand/or subture of any profession. Technical tasks, consciouslydetermines the value of though they may require great skill, everythmg. deal with a relatively limited number of unique variables, and therefore do not

as the seminal cause of the great divide. The premise that the division is due to philosophy, i.e., philosophy v. no philosophy, the Palmer philosophy or vitalism v. mechanism, has been generally accepted with little examination. One side espouses that we are brothers in the philosophy and that acceptance of the vitalistic or Palmer philosophy is necessary to unite the profession. The other side contends that the profession has outgrown its need for philosophy, and were it not for philosophy, or the Palmer philosophy, we could unite. Philosophy has little to do with the division. However, because this premise is so widely accepted and relied upon by both sides, it is important that its validity be thoroughly tested.

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vitalism and mechanism have existed for require a philosophy for their perforthousands of years. Both have adherents mance or the determination of their in all the physical and biological disciimmediate effects. The immediate plines without causing those disciplines effect of adjusting subluxated vertebra to suffer the fracture that exists in can be determined by science. The remote effects, as well as the integrating chiropractic. I would venture to say that there is about the same perof many technical tasks into a strategy centage of vitalists and mechanists wherein a spine can be maintained subluxation free with the least intervention, in each of the divisions within chiropractic. requires a philosophy. Philosophy, consisting of the normative Under the vitalistic philosophy, as taught at Sherman College, one would find value, sciences (epistemology, logic, ethics, and with the proper technical training, value theory and esthetics) and metacould practice correcting vertebral physics, offers the best hope of understanding and resolving our profession’s subluxations, physiotherapy, surgery, pharmacology, farming, engineering, division and fostering its continued etc. Many allopaths and pharmacists are existence. The Bible says, “Come, let vitalists and view their interventions, us reason together.” Come, let us have a philosophical discussion about reality relative to the body’s innate striving to and the horizons of possibility that exist live most autonomously, similarly to for our profession. Let us seek answers those who correct vertebral subluxations. to the questions, “Who are we and where Vitalists undoubtedly practice their arts are we going?” Empirically we know the differently than do the mechanists. profession suffers from a major diviA vitalist does not suspend vitalism in sion. We know some of the direct costs order to use the scientific method to of the division, but the full grounds and investigate physiological mechanisms signrficance of that division and the or some other limited part of reality. complex of presuppositions and impliThe vitalist understands that through cations of recommended remedies can science he can learn about certain only be evaluated through philosophy. aspects of reality. Philosophy Not the Center of One philosophy can value many the Profession’s Division practices, and one practice can Philosophy is not the proximal cause of the profession’s division for two reasons. First, because no profession has an u prtorl claim to “a philosophy,” neither general philosophy nor any particular philosophy, a profession cannot claim ownership to a view of reality or any of its parts. There cannot be one reality for chiropractic and another for dentists or accountants. There can be no more a chiropractic philosophy than there can be a chiropractic science. Philosophy determinesvalue - the degree to which a thing or act supports survival. A thing or act may have value under a broad spectrum of philosophies. The philosophic perspectives of

have value under many philosophies. If philosophy were the cause of our division, the medical profession, as well as other professions, also would be divided. While all medical schools teach according to the mechanistic model, I believe most medical students enter and graduate as vitalists. Art

Art also has been cited as a cause of the

division. By hands only! Physiotherapy or no physiotherapy! Conservative health care! Without drugs or surgery! Like philosophy, art will, and should, always be the subject of meaningful debate. However, art could not be the

primary locus of the profession’s major division. The effectiveness of art is determined by mission. Any debate about an art is meaningless, unless the mission of the art is first determined.

Mission, not art, is at the center of the chiropractic profession’s division. Mission is what defines a profession. Mission tells what a profession eternally strives to do; art tells how it currently expresses that striving. Professions are defined by their mission, not by the methods currently used to achieve their mission. The methods used should be those that are most effective, safe, economical and practical in accomplishingthe mission. It would be wrong to insert into a definition of a profession, a reference to methods, i.e., “by hands only” or by natural or conservative means. To state that the mission of chiropractic is to render “conservative health care,” is wrong for another very important reason; all professions attempt to accomplish their missions with the greatest economy of effort and the least intervention. Conservativenessin fulfilling a mission is the essence of any art. Professions can not be defined in the negative; by the methods that are not used to achieve their missions, i.e., without drugs and surgery; or in terms of what it is not, i.e., non-therapeutic.Public and private regulatory bodies may describe “acceptablepractice methods,” but those descriptions are just that, and are not part of a profession’sdefinition. As mission drives methods, philosophy

drives mission. Philosophy prioritizes possible missions according to their contribution to survival. The mission to seek or not seek chiropractic care, or to be or not be a chiropractor is determined by philosophy. People with seemingly similar or different philosophies, because of the nuances of those philosophies, may have different

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priorities. Those nuances play a role in ple with that mission. If philosophy the profession’sdivision by raising such and art justified the existence of a profession, there would be hundreds of questions as, “Should chiropractors’ chiropractic professions and thousands practices define the profession or should the profession define chiroprac- of medical professions. tors’ practices?”“Is a practitioner’sfirst To justify the existence of chiropractic priority to make a living by fulfilling the on the basis of its having a different perceived needs of a society ignorant of philosophy, and/or different methods the profession’smission, or is it to (methods that may be better, more advance the integrity of the profession conservative, less expensive, faster, safer by educating the members of society as and/or more gentle or natural) than to the mission of the profession?’ While those of medicine, is to believe that philosophy does influence the division, chiropractic is a temporary profession its influence is at the level of determin- whose purpose is to protest the direcing mission. tion and/or methods of the medical profession. A profession does not require, nor should it desire, uniformity of philosoph- Looking at philosophy, science and art ical, scientific and/or artistic beliefs. If as the loci of the profession’sdivision uniformity were required in matreminds me of the man looking under ters of philosophy, science or art, a street lamp for the keys he lost in an professions would be frozen in alley because the light was better! time, with no progress possible. The Locus of the Disagreement based on philosophy, science and art is a healthy attribute and Profession’s Division is necessary for professional progress. The locus of the chiropractic Philosophy and art should be discussed profession’sdivision is clearly the and debated, but their proper place in matter of professional definition, the scheme of things should be recogi.e., who are we and what do we nized. Members of the chiropractic prostrive to do? I believe both divisions of fession seem to debate beliefs about phithe profession refuse to look at the losophy, and to a lesser degree, science question of professional definition, for and art, as though those beliefs were the the same reason some patients refuse to sine qua non of the profession. Not have their disease diagnosed. They are only does this cause additional and fearful of what they might learn. Also, meaningless fragmentation,it is a dismost chiropractorsare not knowledgeable traction from the real problem, the one about the elements of professional classifithat should be debated and resolved. cation and have given little thought to the Having a philosophy or art different from other professions does not justify and will not sustain the continued existence of a profession. Philosophy and art define schools of thought, but not professions. If a new view of reality were espoused, those who found it to be more valid than their current view would adopt it and begin to align their behavior accordingly. If a new, superior method of achieving a mission were discovered or developed, it would soon come into common use by all peo-

subject. Professional definition tells who we are by stating a central area of interest; and what we do, by stating a central mission for our practice. This premise, that the division within chiropractic has its loci in the profession’s central area of interest and practice mission, needs to be thoroughly examined and tested. If it is true, and I believe it is, conscious decisions about resolution can be made in light of that fact.

It is to a central area of interest that a profession relates, or anticipates relating, all knowledge. If vertebral subluxation were central to chiropractic, the profession would relate everything that is studied to the cause, description and/ or alleviation of vertebral subluxation. The same would be true if disease were central to the profession. A central mission, or “central purpose”

serves a profession in much the same way it serves an individual. That service is well described by Ayn Rand. I have paraphrased her statement, mainly substituting “profession”for “man” A centralputposeserves to inte-

grate all the other concerns of a profession. It establishes the hierarchy, the selective importance, of its values, it saves theprofession from pointless inner conflit, it permits it to enjoy lve on a wide scale and to carry that enjoyment into any area open to its mind; whereas a profession without a centralpurpose is lost in chaos, It does not know what its values are. It does not know how tojudge. It cannot tell what is or is not important to it, and, therefore, it drijis helplessly at the mercy of any chance stimulus or any whim of the moment. It can enjoy nothing. It spends its lve searching for some value which it will neverfind. While a profession’spractice mission tells what its practitioners strive to do, it does not tell how they strive to do it. A profession’scentral area of interest and practice mission, are its reason for being. They are the sine qua non of a profession. The profession’s mission is the standard by which the effectiveness of planning, legislative activity, public relations endeavors, educational and research programs and every other facet of the profession is judged. It is the standard

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by which the appropriateness and effectiveness of practice is judged. A few ways in which various elements of any health care profession would be served by a clearly stated and agreed upon central area of interest and practice mission are:

Practitioners would have a s t a d d by which to measure the value of euery professional decision they muke and the eflectivenessof their care. They would cease depning themselves in t e r n of what they are not, i.e., non-therapeutical, without drugs or surgey, no physiotherafl, outside the parameters of allopathy. Colhges would have a standard by which to measure the value of evey cohgial decision and the eflectiveness of their actions. Eveyone would know thepurpose of each and every aspect of the institution, and there would be a standardfor the appropriation of resources. There also would be a standardfor the establishment of admission requirements, curricula, etc. Researchers would have a standard by which to prioritize the relative importance of research proposals and the allocation of resources. Patients would have a basisfor deciding when and how to utilize the services of a chiropractorand could deuelop a consistent expctation as to the outcome of care. Professional associations would have a sound basis by which to prioritize and evaluute their activities and long rangeplans. This wouldpromote a continuity of direction and eflortfrom one administration to the next. Legislatures, courts and administrative agencies would have a stan-

dard by which tojudge the nee&, requestsandperfomnce of the profession and itspractitioners. A raison d etre is to a profession what DNA is to a human. It is the 2?denti&ng and Zimiting element. It identifies the

allopathic medicine, should it not have the same educational program and practice standards as allopathic medicine? Is this the reason chiropractic education looks more like medical education with each passing year?

profession and implicitly limits the area Those who believe the mission of chiroof its expression.A raison d‘ etre is to practic is to get sick people well and a profession what wood or marble is to keep the well from getting sick, believe a statue. Philosophy and science are the similarly to those who advocate chirosculptors. A sculptor shapes existing practic being conservative health wood or marble into a priceless master- care or the conservative use of drugs piece or something less. Philosophy and and surgery for the elimination of science shape an existing profession disease and pain. The latter probably in quite the same manner. could argue successfully, with those who subscribe to the “getting the sick A profession’s mission has varying well” theory, that some drugs and surgdegrees of value under different eries may be more effective, safe, and philosophies. Each philosophy less invasive and expensive methods of examines the pre-suppositions that accomplishing that mission than vertegive rise to a mission, and the far bral adjustments or physical therapy. reaching implications that might

result from its achievement. Those varying philosophies will influence how a mission is expressed in practice (the art), but do not change its fundamental nature.

With the establishment of a professional mission, debate about the use of any method would become scientific rather than philosophical, in nature. AU methods would be subject to the same test, demonstrated effectiveness against an Practitionerswith the same mission, agreed upon standard, the profession’s regardless of differences in their methods mission. or the names of their professions, are in the same profession. Because mission The mission statements of chiropractic drives methods professions with the organizationsand colleges are often same mission soon have similar methvague. They contain too many adjectives ods. The best method of accomplishing and adverbs, allowing everyone to a mission will be adopted by all practi- impute their own meaning onto them. tioners of that mission, regardless of A good mission statement uses action what they call their profession or art. verbs, nouns and direct objects and not Philosophical, scientific and artistic beliefs many adjectives, adverbs and passive arise from reason, are constantly evolving verbs. Phrases such as, primarily the spine, primarily the nervous system, and unique to each practitioner.A conservative methods of promoting professional mission (definition) arises health, mainly low back conditions, from authority, is fixed and unique to mainly conditions of the spine, are each profession. Because mission is meaningless and lead to an amorphous fixed, it is ideal to serve as a profesprofession. sion’sidentlfylng feature. Should not all professions, with the same mission, be held to the same educational and practice standards?If chiropractic has the same mission as

Often, mission statements in chiropractic are written at levels of abstraction that are far too high. This is probably done in order to bring about consensus among groups with different missions, or to hide

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agendas. If a mission statement is written on too low a level of abstraction (‘‘by hands only” - B.J. Palmer) the profession will stagnate, and if the mission statement is expressed on too high a level of abstraction (“Chiropractic ‘exists’ because of its service to human beings. That’s our purpose.” - Leonard Fay) the profession will become amorphous. On a very high level of abstraction chiropractic is a “service to human beings.” On a lower level of abstraction it is a “healthservice.”On a meaningful level of abstraction, in terms of professional definition, it “contributesto health through achieving....”

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Vague statements of mission have allowed problems of professional identity to exacerbate. Practitioners should know and be able to state clearly the mission of their profession. I doubt that anyone could state, at a meaningful level of abstraction, an agreed upon mission for chiropractic. In order to communicate among ourselves we must d e h e our terms and check our premises. Members of the profession seem united in their desire to achieve greater professional unity, particularly on their terms, but appear to have little understanding of the concept of unity. Unity can exist only relative to an idea. Oxynorons, such as, “Unity without uniformity,” must be recognized for what they are and discarded. Ideas are the only things upon which unity can exist, and on those ideas about which unity exists also exists uniformity, There can be a unity of mission, without a uniformity of philosophy, science or art, but there cannot be a unity of mission without a uniformity of opinion as to mission. There can not be a unity of philosophy, science or art, if such were desired, without a uniformity of opinion relative to philosophy, science or art. A profession must determine those elements upon which unity must exist.

The division within chiropractic is often described as two “schools of thought.” In reality the division is deeper than two “schools of thought.” ‘“ho schools of thought” refer to alternative means to the same end. Clearly the division within chiropractic relates far more to ends than to means.

2. The kinds of conditions treated

There are three differing views within chiropractic, two of which are based on different professional missions. The mission of the third division is not clearly defined. Each of the two major divisions has the elements of a profession; one, of a profession separate and distinct from all others; and the other, currently differing from allopathy only in some of its methods.

3. The standard by which the effectiveness of the intervention is measured, is the degree to which pain or disease is alleviated. That which maintains the body free of pain and/or disease with the most safe, economical and practical intervention, is best.

The first view of chiropractic: 1. The mission is to contribute to

health through the correction of vertebral subluxation. 2. Vertebral subluxation is an

aberrant condition of a vertebral articulation that disturbs nerve function. At present, vertebral subluxation is not well understood, but is believed to impair the body’s striving to maintain health.

3. The standard by which the effectiveness of the intervention is measured is the degree to which the vertebral subluxation is corrected. That which maintains the spine subluxation free, with the most safe, economical and practical interventions, is best. 4. Chiropractic examination and care are not substitutes for examinationsand care performed by other professions. The second view of chiropractic: 1. The mission is to contribute to

health through the alleviation of pain and disease conditions.

are presently limited, and those limitationsvary according to practitioner preferences, training and state law. Today musculoskeletal conditions, particularly acute, idiopathic, low back pain, are its main focus.

4. Chiropractic examinations and care are substitutes for certain levels of examinations and care performed by allopathic, osteopathic and naturopathic physicians. The third view of chiropractic: 1. The mission is to contribute to

health through the correction of the cause of disease.

2. This may address some or all

conditions.

3. The standard by which the effectiveness of the intervention is measured is either the correction of an articular subluxation and/or the alleviation of pain and disease. There does not appear to be a criterion as to when one, the other, or both standard(s) is used.

4. Practitioners administer “adjustments” according to various criteria, i.e., when patient is found to have an articular subluxation, pain or disease, or according to a universal lifetime schedule (once a week, every two weeks, etc.) 5. Chiropractic examinations and care are substitutesfor examinations and care performed by other professions.

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How does the profession reconcile its different missions?Because of the nature of the division, it appears the profession has four options: 1) Continue the present situation, each side changing strategies as necessary, until one or both sides is driven from the field. 2) One side abandons its orientation and joins the other. Because each side has a degree of scientificvalidity and social usefulness and its members are trained consistent with their present model of chiropractic, it is unlikely that the practitioners within either division, spontaneouslyor under compulsion will abandon their valid and useful practice for that of the other division. 3) An honorable or dishonorable schism occurs. 4) Accept the Camelot option, where all chiropractors continue in one profession, but, unlike today, each practitioner respects the rights of all practitioners. The Camelot option would probably be temporary. Aside from the fact that, ideally, each side has different educational and practice requirements, it is highly unlikely that each side will prosper equally, and human nature does not seem to allow one side to watch, unaffected, another side enjoy greater prosperity, no matter how justly that prosperity is achieved. The foregoing is my analysis of the problem. I confess that I do not have a practical long term solution, but I believe no problem can resist a fair and equitable resolution if all parties sincerely desire one. Knowing the nature of our problem, it seems that accommodationrather than unity should be our goal. We must persist, if there is to be any hope of a resolution, and recognize that the ultimate answer to all social problems is spiritual. Problems exist as opportunities for spiritual growth. We should seize this opportunity with patience and optimism. I offer the following suggestionsfor the achievement of a temporary solution:

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1. Go for the Camelot resolution. We

for leadership from women and men of don’t know how long “temporary” discerningwisdom. may be.

2. Develop high, but pertinent standards of education and practice, that are within the context of practicability, and recognize and respect the traditional differences of mission that exist.

IT IS IN FOSThXlNG HEAW”

2HA.T W?BECOME HEALER9. lHE OPPORTuNIm TO FOSTERHE4LLNG WZWIN OUR PROI?ESSION IS BEFORE EACH OF US!

3. Refrain from making value judgments outside one’s area of expertise.

4. Continue discussion as to the

source of the division and the possibilities for an accommodation.

5 . Inspire the members of the profession to act ethically, practicing the Golden Rule toward all chiropractors, and be aware that the one thing we have in common is a calling to make life better for others.

6. Increase intra-professional dialogue. Share information and ideas in a respectful and professional atmosphere, through an exchange of lecturers, faculty, journal articles and debates. A more reasoned view of vitalism, the profession’smission and/or reality can be achieved by strengthening and encouraging pluralism in our colleges’philosophy departments.

Conclusion The locus of the profession’sdivision concerns the issue of its reason for being. There are two very different groups calling themselves “chiropractic.” Because both groups serve the needs of patients, this situation is unlikely to change. However, there is much that can change that would serve all elements of the profession, its members, individual patients, society and our own souls. Appropriate change calls

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