Leboeuf-Yde Charlotte, Innes Stanley I, Young Kenneth J, Kawchuk Gregory Neil, Hartvigsen Jan
1Institute for Regional Health Research, University of Southern Denmark, DK-5000 Odense C, Denmark.
2School of Health Professions, Murdoch University, Murdoch, Australia.
Chiropr Man Therap. 2019 Feb 21;27:4. doi: 10.1186/s12998-018-0221-z. eCollection 2019.
The chiropractic profession has a long history of internal conflict. Today, the division is between the 'evidence-friendly' faction that focuses on musculoskeletal problems based on a contemporary and evidence-based paradigm, and the 'traditional' group that subscribes to concepts such as 'subluxation' and the spine as the centre of good health. This difference is becoming increasingly obvious and problematic from both within and outside of the profession in light of the general acceptance of evidence-based practice as the basis for health care.Because this is an issue with many factors to consider, we decided to illustrate it with an analogy. We aimed to examine the chiropractic profession from the perspective of an unhappy marriage by defining key elements in happy and unhappy marriages and by identifying factors that may determine why couples stay together or spilt up.
We argue here that the situation within the chiropractic profession corresponds very much to that of an unhappy couple that stays together for reasons that are unconnected with love or even mutual respect. We also contend that the profession could be conceptualised as existing on a spectrum with the 'evidence-friendly' and the 'traditional' groups inhabiting the end points, with the majority of chiropractors in the middle. This middle group does not appear to be greatly concerned with either faction and seems comfortable taking an approach of 'you never know who and what will respond to spinal manipulation'. We believe that this 'silent majority' makes it possible for groups of chiropractors to practice outside the logical framework of today's scientific concepts.
There is a need to pause and consider if the many reasons for disharmony within the chiropractic profession are, in fact, irreconcilable. It is time to openly debate the issue of a professional split by engaging in formal and courageous discussions. This item should be prioritised on the agendas of national associations, conferences, teaching institutions, and licensing/registration as well as accreditation bodies. However, for this to happen, the middle group of chiropractors will have to become engaged and consider the benefits and risks of respectively staying together or breaking up.
整脊疗法行业长期存在内部冲突。如今，分歧存在于专注基于当代循证范式的肌肉骨骼问题的“循证派”和秉持“半脱位”及以脊柱为健康中心等概念的“传统派”之间。鉴于循证实践作为医疗保健基础已被广泛接受，这种差异在行业内外都日益明显且成问题。由于这是一个需考虑诸多因素的问题，我们决定用一个类比来说明。我们旨在通过界定幸福与不幸福婚姻的关键要素，并找出可能决定夫妻是继续在一起还是分手的因素，从一段不幸福婚姻的角度审视整脊疗法行业。
我们在此认为，整脊疗法行业内的情况与一对不幸福的夫妻非常相似，他们因与爱甚至相互尊重无关的原因而维系婚姻。我们还认为，该行业可被概念化为存在于一个连续体上，“循证派”和“传统派”分别处于两端，大多数整脊治疗师处于中间。这个中间群体似乎对任何一派都不太关心，并且乐于采取“你永远不知道谁以及什么会对脊柱推拿有反应”的态度。我们认为，正是这个“沉默的大多数”使得整脊治疗师群体能够在当今科学概念的逻辑框架之外开展业务。
有必要停下来思考整脊疗法行业内诸多不和谐的原因是否实际上无法调和。现在是时候通过进行正式且大胆的讨论来公开辩论行业分裂的问题了。这个议题应在全国性协会、会议、教学机构、许可/注册以及认证机构的议程上被列为优先事项。然而，要实现这一点，中间的整脊治疗师群体将不得不参与进来，并考虑继续维持或分道扬镳各自的利弊。
