24 May 2016

The Vitalism Debate

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The Vitalism vs (Research) Paper-based debate and division of chiropractic needs to end. Neither is truthful and the artificial distinction ultimately leaves the majority of chiropractors out in the cold.

Vitalism was discredited when Hermann Kolbe synthesized acetic acid from inorganic substances obtained from pure elements in 1845. Originally, vitalists had maintained that “life force” was necessary for the creation of organic (live) material as distinct from other (inorganic) matter. Thus, vitalism originally asked questions about the nature of life itself which chiropractors really don’t address, until and unless we start adjusting broccoli, grasshoppers or amoeba. We can, if we wish, point current mechanistic definitions as being unable to quantify that which is present 10 minutes before death and absent 10 minutes after death but again, this is not an area habitually inhabited by chiropractic practice.

Current chiropractic vitalists have changed the definition and use it to define a view that the body has the ability to heal itself unless or until there is an interference to that ability. Sadly, the Vitalist position is still clouded by the theistic concepts of “life force,” “soul,” “Innate Intelligence” and “Universal Intelligence.”

The Research Paper argument follows the Evidence-based Practice model advanced by Sackett and colleagues in the early 1980s which has been universally adopted by modern medicine whereby good practice is informed by evidence (usually meaning RCT based peer-review published evidence), practitioner experience and patient preference.

The problem is that neither of these approaches come close to describing what we actually DO in practice so neither camp is a place the majority can really call home.

Rather than identify with a set of beliefs, the solution to this division is to identify what we ACTUALLY do rather than what we think we do or ought to do. In the process, name it appropriately and it will become somewhere everyone can belong – free of beliefs, irrational hope, tradition and dogma.

No matter which camp you belong to – when you are faced with an individual patient with their unique presentation and history – what you actually do is to return them to a “more normal” or “optimal” state of function. Whether you are aiming to “create and maintain wellness” or “treat low back pain” your objective is to return THAT PATIENT’S PHYSIOLOGY (and by physiology I refer to the entirety of their physical being including their neurology, chemistry and structure) to normal or towards normal.

It is tragic that nowhere in Sackett’s vision of evidence-based practice does the patient’s physiology even rate a mention.

This might suit the medical model of practice where every symptom is a condition, every condition is unique, causes are unknown and every condition demands a (unique) treatment and that treatment is independent of the skill of the provider but it simply will not do in the realm of any patient interaction where every treatment is variable dependent on the art and skill of the practitioner. In this environment the uncertainty of the presentation, the environment, the condition and the treatment mean that randomisation cannot control the experiment to answer the question being posed (in the same way it can if the treatment is a drug or a substance). It is therefore impossible that ANY population-based research paper can determine the optimal treatment of any individual patient. Practitioners who insist on applying an average result of a treatment of a condition to a patient have forgotten that their task is to treat THAT patient – not a condition or a population. That patient and their presentation is unique and to base their treatment on the statistical difference between the average of two groups is gambling with that patient’s welfare in a way that is beyond belief. While the idea of “patient-centred AND evidence-based” might be appealing, it is a contradiction that should not exist. If the evidence is population-based then it cannot inform what is optimal for that patient and if it is patient-centred then it is not based on evidence.

The only way to address the needs of any individual patient is to examine their physiology and return it to normal as quickly and efficiently as possible. Whether the technique you use has been shown through research to be effective in 99% of patients or 1%, if your patient is the one percent, you had better use (or not use) that technique and no amount of scientific research should deny you the right to use that technique in that instance if that is in the patient’s best interest. Of course, if a technique has been proven to be ineffective in 100% of patients, you definitely shouldn’t use it, ever.

Whether you are vitalist or paper-based, what you actually do is assess physiology and make it better.

Physiology is impaired by the forces of deficiency and toxicity, internal and external. Deficiencies and toxicities need not be chemical. We may suffer a deficiency of movement or exercise or we may suffer the toxicities of trauma or emotional abuse and all of these things may affect our physiology. Every natural medicine practitioner then seeks to strengthen (or optimise) the body of their patient or remove the forces it is subjected to. This is our common goal, our common practice and should be our defining characteristic.

Let us end the vitalism/evidence-based split and focus on what we all ultimately do – physiology-based practice.

In this model of practice, our knowledge of physiology can be informed by published research, anatomy, neurology, observation, experience, experimentation, trial and error, advice, philosophy, anthropology, geography, chemistry or physics. As long as our knowledge is informed by reality, then vitalists, EBP advocates and everyone else can continue to practice secure in the knowledge that they are always acting in the best interest of their patient and we can stop the witch-hunts that seek to shut down those with similar practices but different ideals.

 

Read Part II here ⬈

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