From: www.ChiroViewPresents.com A recently broadcast between Dr. Wenban and Dr. Winterstein regarding the article "Identity and Integrity". Dr. Winterstein's personal response that also accompanied the article he sent to American Chiropractor, which did appear in the recent broadcast. So here is Dr. Winterstein's comments along with my sincere apology for this rather foolish oversight: February 2, 2001 Dear Dr. Wenban, I have received you second letter in response to mine. Thanks again for taking the time, and for providing your insights and perspectives. I am attaching a recent article I wrote for the American Chiropractor and which was printed in their last edition. In this article, I suggest that what we must do, as a profession, is develop a concept of intra-professional harmony that will allow all of us to participate in a profession that is currently very broad in its principals and is legal in its many forms. It is with this idea in mind that I am responding again to you, for I believe that if people of good will continue to communicate, there is a tendency for the common ground to become larger and more comfortable. Now, to some specifics. In your letter you refer to an article authored by Howard Wolinsky and from that article, you draw some conclusions about National University of Health Sciences, its graduates and me in particular. It seems only proper then that I should set the record straight regarding what is going on in the NUHS/AMI setting. It is correct that a number of our graduates are functioning as primary care gatekeepers in the AMI HMO under Blue Cross/Blue Shield of Illinois. Yes, they are doing all of the procedures required of a PCP and doing them so well that the outcomes over the past two years are outstanding. In fact, in our HMO, there were , 60% fewer hospitalizations, 85% fewer outpatient and surgical procedures, and 56% lower prescription pharmaceutical use rate when compared to the usual values found in the allopathic IPAs which are part of HMO Illinois. Just on the surface alone, that sounds to me as though our chiropractic physicians were quite successful in carrying out some of the primary objectives of our profession and, in fact, hits the main one right on the head. The ACC document to which you refer states that the purpose of the chiropractic profession is to optimize health. At AMI, that is exactly our purpose as well, and we could think of no better way to do this than to place broad scope chiropractic physicians at the gate. Our patients are seen by the DC on average once every 3 weeks and because of that the costs are very significantly lower as is borne out by our statistics (from BC/BS). You see, Dr. Wenban, one of my problems with your argument is that you seem to place the wants, needs, desires and beliefs of our profession above those of the patients whom we serve. For me, chiropractic and the people who practice it are only valuable if we can definitively produce something of value for the people we serve. If we do not, there is no reason whatsoever for us to exist. I have become nearly disgusted with the constant babble in our profession about how "passionate" someone is about chiropractic. In fact, today, among the straight oriented chiropractors, if you are not "passionate" about chiropractic, then you are next to nothing and you don't have the "big idea," etc.etc. In fact, you are not even a "real chiropractor!" I for one, resent that implication and I think everyone in our profession should resent it too. If our only emotion is for our profession then we should not exist. Our true feelings and our intellectual efforts should be first and foremost directed toward helping people and finding ways to demonstrate objectively that what we do for people really is in their best interests. Now, you suggest that there is a major contradiction because the ACC document which I signed, uses the words "without the use of drugs and surgery" and yet, you state, our graduates (NUHS) "end up prescribing antibiotics and other medications." Well, my colleague, that is what comes from believing all you read in a newspaper article. NUHS graduates do not give any patients prescription drugs. That is one of the real beauties of the AMI system. All prescriptions written (and remember that because of the chiropractic management of patient's problems this is less than 50% of the amount written in an allopathic based HMO), are written by one of our two allopathic physicians who work out of the home office. What is next is even better for the patient. How is it that the MD writes a prescription for the chiropractic physician's patient? It is based upon the knowledge of the DC who evaluates the patient, tries first to resolve the problem and only when chiropractic methods are not working, consults with the MD and indicates the diagnosis. Together, then the DC and the MD decide what will be the best path to follow for the patient and that is what is done. All efforts are directed toward the best interests of the patient and neither professional is worried about whether one or the other gets credit or whether one is better or above or under etc. In our model the allopath is a specialist to whom the chiropractor turns when necessary. You choose to suggest that teaching our students about pathology and microbiology amounts to "medicalizing" chiropractic education. Your words could have been taken from the mouth of T.F. Rattledge, D.C. who resisted increasing educational standards in chiropractic in the mid 30's, because like you, he believed that this was a "medicalizing" of the profession instead of informing the professional who intends to practice a healing art. In some way, you suggest that by doing this, the need for the chiropractic profession will be eliminated as, you suggest, has happened to the American Osteopaths. My dear colleague, you should take the time to read some Osteopathic publications for you would find that they do not see themselves as disappearing from the healing scene at all. In fact, this profession has grown from fewer than 15,000 practitioners when I was in chiropractic college 36 years ago to over 50,000 today. The osteopathic program at Midwestern University which is less than five miles from where I sit, has absolutely no difficulty filling its classes. That is disappearing profession? Regarding the methods of instruction and the inculcation of legitimate principles of chiropractic practice into the educational process, I agree with you. It is my experience that often, the Ph.D. members of the faculty are just as convinced as anyone that the methods of healing which apply to the pathologies which they teach are open to thoughtful consideration. You see, Dr. Wenban, nothing is more convincing to a student, regarding the value of chiropractic care for a patient, than the fact that a particular patient recovered from a circumstance that was clearly pathological through the application of chiropractic methods. Thus, teaching them the details of pathology and microbiology, when juxtaposed with the application of chiropractic methods is, in my opinion, one of the best ways for them to develop confidence in what we do as chiropractic physicians. At the most recent new student orientation here at NUHS, part of my involvement included the presentation of case histories of patients with: 1. Acute lumbar disc syndrome 2. Peptic ulcer of the lessor curvature of the stomach 3. Aspiration pneumonia due to Zenker's diverticulum 4. Acute viral pneumonia in a 9 year old boy 5. Acute stable lumbar fractures in a 75 year old female 6. Peptic ulcer of the antrum of the stomach 7. Osteochondrodystrophy in a male of 29 years 8. Arnold Chiari Syndrome in a 16 year old with paresthesias of two digits. 9. Others All of these patients were managed by me, and all, fortunately were helped. This freshman class will not soon forget that it was a chiropractic physician who helped these patients recover from real demonstrable verifiable human diseases. I do not worry about the "slippery slope of reductionism," because our students see the real circumstances of their patients and they see the value of chiropractic care for these people and their problems. Furthermore, when it comes to holism, no other institution can claim the heritage in holism that we do. Certainly the original chiropractic principles were anything but holistic. They focused entirely upon a single entity as the cause and a single procedure as the cure of all of human ailments and health circumstances. In contrast, John Fitz Alan Howard, founder of National promoted a true holistic approach to human health and healing as has every president since then including yours truly. The following quote comes from an article I wrote for the ACA Journal a number of years ago: "Because of the inextricable nature of system inter relationships within the human organism including those which are clearly physical in nature as well as the effect of the mind, doctors of chiropractic will be trained to address the organism as a whole. Thus, we will consider ourselves to be holistic practitioners." Holism, as a concept, requires the understanding that the "whole is greater than the sum of its parts." This concept has nearly a century of understanding and acceptance here at NUHS and is very much alive today. You kindly offer some recommendations for the educational process in our DC programs, which, by the way, is not undergraduate study in the United States, but rather a "professional program," leading to a First Professional Degree. Here at National, all entering student are required to have their undergraduate study completed (BS/BA). 1. Your first suggestion is that we should ensure that what is taught at all levels reflects the fundamental philosophical constructs and core values to which chiropractors ascribe. I would ask, "just what might those constructs be? Surely not Stephanson's 33 principles. Perhaps they would be the 11 principles taught here at NUHS? You decide, and then we can discuss whether or not the various DC programs should all teach them. While you are about this process, you might investigate whether or not other health care teaching institutions ascribe to a fixed set of principles. Unfortunately, doing so simply undermines academic freedom and the freedom to investigate the epistemologic underpinnings of the principles. 2. You suggest that basic science educators should undergo a 12 month training program about how their area of expertise relates to the "philosophy of chiropractic." I would be interested in seeing that syllabus. 3. Again you believe we should teach less pathology and microbiology. I disagree completely. This is not about "how we look in the eyes of the regulators." It is all about becoming, as you say "excellent chiropractors," and I fail to understand how a good rigorous education in the basic sciences can make us poor chiropractors. This harks back to B.J. Palmer who taught that too much education constipates the mind! As far as I am concerned, the more fully educated our students are about human health and disease, the more completely they will be able to function as chiropractic physicians. I suspect that you would think this is exactly where I have gone off the sacred path, because, in the context of your kind of chiropractic, this is all irrelevant, since all chiropractors should do is locate and correct spinal subluxations for the purpose of releasing innate intelligence to correct and heal the body and mind. And this, my friend is really at the crux of the matter - at the crux of the entire argument. I do not believe you are in possession of the evidence that this is a viable, valid, reliable form of healing of human ailments, nor, for that matter a valid and reliable form of maintaining health. You may very well believe it and by your definition, because you do, you have integrity, but by my definition of integrity, you then have the responsibility to objectively demonstrate that what you believe really is true. Now before anyone takes me out to hang me, hear the rest of the story. As a chiropractic physician for the past 32 years, I have held to the belief that biomechanical disorders of various kinds do negatively affect general human health. Furthermore, I have held to the belief that treatment (and correction if possible) of those biomechanical disorders does improve general health. What I have not been able to do is demonstrate this belief in an objective way. Does that matter to the patient who sees me for complaints of stomach pain and in whom I diagnose a peptic ulcer and for whom complete healing follows a course of spinal adjustments? Of course it doesn't, but it does matter to the society to whom I intend to sell my belief because they want and deserve more than my belief and my promise. This is exactly what scientific investigation is all about. This is also why, it is so important that I serve NUHS which has a strong commitment to scientific investigation - to the ! discovery of new knowledge and learning the truth about that which we do. I am not so naive as to believe that allopathic medicine is altogether scientific. I have read David Eddy also, but I want more than tenacity underpinning my promises to my patients. Within society, I have a responsibility, especially as a healer, to represent the truth, for the sick and suffering are vulnerable to any kind of promise and I have taken on the professional mantle of altruism in relation to my patients. It then behooves me to be as certain as possible that what I tell my patients and what I do for my patients is in their best interests. It is my responsibility then to ask the simple question; "Is what I believe about the chiropractic concept the truth?" How do I know it is? Charles Peirce (actual spelling) says there are basically four "ways of knowing - four way of fixing our beliefs." These are: 1. The method of tenacity - I believe this is true because I know it is and you have no right to question me! It must be true because I believe it is. 2. The method of authority - I believe this is true because someone in authority says it is true. 3. The a priori method - I believe this is true because it makes sense - it stands to reason. 4. The method of science - I believe this is true because a set of experiments that occurred outside of my ability to affect the outcome attested to the fact that this is true. The obvious question then, is where does our thinking, where does our position fit into this epistemological hierarchy? In the ACC document, we stated that we will use the highest level of evidence to support our chiropractic practices. Which of the four do you believe represents the highest level of evidence? I am well aware that some chiropractors and others will argue that there are other ways of establishing the truth. Some say the typical scientific experimentation model does not fit chiropractic healing - that we cannot properly control an experiment but while those arguments are going on, some of us in the profession continue to pursue scientific support for what we do. In that specific vein, it might interest you to know that at NUHS right now, there are 32 research projects in process (I believe that is more than at any other single institution in our profession) including studies on low back pain, chronic pelvic pain in the female, zygapophyseal joints and spinal adjusting, immune function following manipulative therapy, joint dysfunction and autonomic dysfunction, flexion distraction vs. allopathic care for neck pain, and a small animal model of vertebral subluxation (in conjunction with Palmer). Sorry, since you took a couple rather pointed shots at NUHS, you should know also what we are really doing for the profession. While I am at it, I might just mention that we are the only institution in the chiropractic profession that has provided the profession with a peer reviewed and medically indexed journal since 1978, and the only one with a journal dedicated to "chiropractic humanities" and the only one with a journal dedicated to "chiropractic technique." You might say that I am passionate about my institution but knowing how much I dislike that word you might simply say that I am intellectually enthusiastic about all that is being done here at National University. 5. You suggest that a larger portion of the professional curriculum should be devoted to teaching students how to think critically and creatively. Perhaps it is safe to say that you are behind the curve of what is and has been in effect for some time. At LACC and also here at NUHS, a fully integrated problem oriented learning process has been in place for 8 and 5 years respectively. I must add, that in these institutions at least, the subjects you suggest should be added are part of the undergraduate studies with which the student enters our Universities. As far as critical appraisal of the biomedical literature is concerned, it has been taught for years here at NUHS. Incidentally, while it is clear that the process of understanding human function, health and disease is changing, and while people are beginning to embrace a more holistic model, I will not be so hasty as to suggest that the more traditional thinking is bankrupt as you state. There is also an ethereal nature to much of what is being suggested today and as time passes, and people begin to discover that the resulting promises are less and less dependable, we will see a return to at least some mechanistic approaches especially as they relate to the epistemologic process. Where you see contradiction, I see recognition of change. Our Palmerian principles are just as subject to change as are the Newtonian principles and we must be open enough in our thinking to recognize that without becoming "weak in the knees." Metaphysics? You are exactly correct when you say that our past is based in metaphysical concepts. It is unfortunate that our original metaphysical principles have not been scrutinized under the bright light of the other pillars of philosophy such as logic, ethics, and epistemology. When principles remain metaphysical in nature, they remain in the "abstract" and thus are unverifiable. They are theoretical and even a high school student knows that a theory is no good without the process of objectification that brings truth or falsehood to the theory. In conclusion, I find myself, as a chiropractor and a chiropractic educator less concerned about our profession remaining separate and distinct than I do about our profession being dedicated to the health of the human race through means that are the least invasive, the least costly and most likely to promote optimum human health. There is no pharmaceutical prescription for optimum health. It can only come from good teachers, physicians who are dedicated to the concept that the human organism is self regulating and self healing, but who also know that this is not the whole picture - who know that at times it takes a skillful, highly educated surgeon to put the pieces back together or a highly knowledgeable psychiatrist to help the person repair the mind, or a highly knowledgeable and skilled chiropractic physician who will make the correct adjustment or recommend the correct dietary change. You are correct. This is not a simple process and I believe it takes all of us if we can just find a way to live together without constantly trying to tell each other what chiropractic really is! Best wishes, Jim Winterstein, D.C.