In the ninth century, a team of Chinese alchemists trying to synthesize
an “elixir of immortality” from saltpeter, sulphur, realgar, and dried
honey instead invented gunpowder.
In the ninth century, a team of Chinese alchemists trying to synthesize an “elixir of immortality” from saltpeter, sulphur, realgar, and dried honey instead invented gunpowder. In 1675, acting on a tip, German alchemist Hennig Brand stored 50 buckets of urine in his cellar, hoping that he could concoct a means to turn the aromatic liquid into gold. Instead, he produced fire. A strange mix of alchemy and chemistry yielded waxy, glowing goo that spontaneously burst into flames – the element now known as phosphorus. Three hundred years later, the male subjects in an obscure Welsh mining town participated in a drug trial of a substance intended to alleviate the worst symptoms of angina. The experimental drug proved useless for controlling the heart condition; however, subjects reported other salutatory effects. It is now sold under the trade name Viagra.
|ABOVE: German alchemist Hennig Brand discovered phosphorus in 1675 while searching for the Philosopher’s Stone – the ability to turn base metals into gold.
Serendipity is the effect by which one accidentally discovers something fortunate, especially while looking for something entirely unrelated. According to the Brazilian scholar, Glauco Ortolano, it “is the faculty of finding things we did not know we were looking for” and the history of science is accentuated with many instances of serendipitous discoveries whose impacts are often as far reaching as they are unexpected. In 1771, Luigi Galvani accidentally discovered that the muscles of dead frogs’ legs twitched when struck by a spark while – according to a popular account – trying to prove that the creatures’ testicles were actually in their legs. The observation made Galvani the first to appreciate the electrical basis of nerve impulses and credited him with the discovery of bioelectricity.
The relationship between electricity and life suggested by Galvani’s observation generated immense fascination with electricity in the popular mind, especially in the earlier part of the 19th century, and many did believe it was, or at least was similar to, the force which caused life. This, in turn, influenced thinkers such as Mary Shelley – leading to the creation of her literary Frankenstein character – and Anton Mesmer, who formulated vitalistic theories of “animal magnetism” that led, by indirect parentage, to D.D. Palmer’s own theories about altered nerve flow as the cause of disease. These theories, coupled with D.D.’s application of a manipulation that is said to have restored hearing to custodian Harvey Lillard, led to the foundation of chiropractic and ultimately to you reading this now. Clearly, Galvani’s serendipitous moment had far-reaching consequences. It is not clear, however, whether he ever found the frog’s testicles.
Though serendipitous discoveries like Galvani’s have had a hand in scientific advancement, for the most part, science advances through the patient application of principles crystallized centuries ago. The cycle of formulating hypotheses, testing and analyzing the results, and then formulating new hypotheses, evolved from methods first employed by early Muslim thinkers who introduced the use of experimentation and quantification to distinguish between competing scientific theories set within a generally empirical orientation. Later, in 1620, Francis Bacon outlined a new system of logic to improve upon the old philosophical process of syllogism and René Descartes established the framework for scientific method’s guiding principles in his 1637 treatise, Discourse on Method.
|Luigi Galvani’s experiments with frogs’ legs identified the electrical basis of nerve impulses.
The nature of research, however, is methodical and self-doubting and advances, though cumulative, are often painfully incremental. The evolution of ideas, like organisms, often proceeds slowly along agreed mechanisms producing gradual changes over very long time frames. But once in a while there is an explosion of ideas so forceful they change our understanding of the world overnight and forever. In evolutionary terms this type of radical shift is known as punctuated equilibrium. In science, times like these are known as annus mirabilis – year of wonders – and history generally recognizes two.
The first was 1666, the year Isaac Newton hit upon the idea of gravitation and made revolutionary discoveries in calculus, motion and optics. The other wonder year was 1905. In this year, Albert Einstein penned the framework of his special theory of relativity and illuminated the photoelectric effect and Brownian motion. The product of these creative outbursts is that, today, we live in both the rational, mechanistic universe envisioned by Newton and the quirky Einsteinian one that operates beyond our awareness. It was as though giants had picked up the entire body of scientific knowledge and advanced it, in several long strides, in a quantum leap forward.
CHIROPRACTIC AND THE SCIENTIFIC METHOD
Although terms such as “research” and “science” were common in the early chiropractic literature, the methods used to elucidate chiropractic theory would have been unrecognizable to Bacon, Descartes and other founders of the scientific method. Part of the apparent incompatibility may have initially stemmed from the vitalistic roots of the profession. Vitalism, a doctrine that the processes of life are not explicable by the laws of physics and chemistry alone and that life is in some part self-determining, was an integral part of D.D. Palmer’s chiropractic vision and is reflected in the vis medicatrix naturae ethic: the healing power of nature, that is – the natural power of the body to heal itself. In Palmer’s healing model, disease was caused by impeded nerve flow, which interfered with the body’s innate ability to heal itself; the spine was the centre of nerve flow and the administering of adjustments to correct misaligned spinal vertebrae could restore health. As originally envisioned, chiropractic was based on deductions from doctrines that relied on vitalistic principles rather than on the materialism of science, and rejected the inferential reasoning of the scientific method.1
|Science’s second annus mirabilis was 1905, when Einstein had some big ideas about relativity and made other revolutionary discoveries.
Initially, the vitalistic principles at the core of Palmer’s healing model – forces which included notions such as Innate Intelligence – were thought by many to be nonphysical and therefore immeasurable by traditional scientific means.2 From the start, chiropractic and the scientific method were uneasy bedfellows.
This early incompatibility led Keating et al. to observe: “In the first 50 years of the chiropractic profession . . . Research was an ill-defined activity, and acquisition of new knowledge did not involve the experimental methodology that increasingly took hold in biology and medicine in the twentieth century . . . Clinical data collection, when it occurred at all, was not described in sufficient detail to permit replication. Results were enthusiastically interpreted as indisputable proof of investigators’ a priori assumptions about the effectiveness of chiropractic methods. A few in the profession recognized the general lack of understanding of the scientific method and sought reform from within”. . . however . . . “Several more decades would pass before a sustained research effort and interest in clinical experimentation would become evident in chiropractic.” 3
Lacking the tools for “legitimate, sustained, scientific research,” chiropractors sought other means to advance the profession.4 Early emphasis was placed on ways to document clinical findings and patient response to care as a means of investigating chiropractic.5 As well, chiropractors were among the first to adopt new technological advances in order to enhance patient care and improve outcomes. In 1895, the same year D.D. Palmer laid the foundation of chiropractic, Wilhelm Roentgen accidentally produced X-rays while studying the passage of an electric current through a gas of extremely low pressure. Chiropractors were quick to make use of the discovery, becoming early developers of weight-bearing and full-spine X-rays as a means of visualizing the entire spine under the effects of gravity.6 Other technological innovations soon followed. “A variety of instruments designed to detect misalignments and the resulting physiological manifestations of the associated neurological disturbance began to appear.”. . . “Consistent with general trends during the first 50 years of the 20th century, instrumentation of all types was designed to provide a more thorough diagnosis and to improve body functions in the hope of instilling longevity by wiping out disease and dysfunction.” 7
Specific to chiropractic medicine was the growth industry in adjustive techniques. Lacking the scientific framework of testing, experimentation and replication of results, chiropractors turned to personal experience in an attempt to optimize clinical outcomes. “With over 300 named techniques, it seemed like every practitioner who turned to teaching introduced a new way to treat a patient. Many of these systems included their own distinctive approach to defining what was wrong with the patient so that the patient’s condition would be consistent with the therapeutic procedure to be administered.”8
Canadian Memorial Chiropractic College(CMCC) professor, and the school’s first research director, Dr. Howard Vernon, notes that during this time, with minor exceptions, most of what could be called research was lodged in this type of practice activity. “Developers of specific techniques and their followers established little foci of data collection where they would track numbers of people and record outcomes that were generally favourable to them. Investigation was not done systematically with verifiable outcome measures and they were likely overstating the case to build support for their particular techniques.”
(Dr. Vernon points out that a notable exception would have been in Europe, particularly in Switzerland, where they attempted to adopt a more rigorous approach. They established the Swiss Annals, held clinical scientific conferences that published conference pieces and began to synthesize scientific explanations for manipulation.)
By the middle of the 20th century, those few empirical studies in chiropractic that did exist suffered from inadequate operational definitions, lack of control comparison and overly enthusiastic interpretations of outcomes.9 In comparison, organized medicine employed the scientific method to full effect and successfully portrayed itself as a scientific discipline based on the experimentally derived basic scientific knowledge that had flourished in the first half of the century. In Keating’s estimation, chiropractic produced no clinical experimentation in its first five decades, a deficiency of which organized medicine was well aware and used to its political advantage.10
Dr. Vernon believes that while chiropractors would have regarded themselves as practising an alternative health model with regard to mainstream medicine, the stronger, more important determinant for chiropractic’s limited scope of research would have been the isolation of the profession, particularly with regard to the way in which chiropractors were educated.
“Chiropractors were educating themselves in their colleges, carrying on their own self regulation and, in many cases, fighting for their existence as professionals. You can also point to the fact that chiropractors were not in the university system and teaching faculty at the chiropractic colleges were themselves chiropractors who had not been educated in university settings and therefore lacked exposure to research methods.”
The general situation through the 1960s and up to the early 1970s, therefore, was of an isolated profession that presented itself, and was viewed as, an alternative approach that didn’t benefit from the training and kind of environment in which individuals in universities pursue research questions. In addition, the need for scientific research tended to be of secondary concern because “the profession,” in Dr. Vernon’s view, “was primarily dedicated to pursuing its own existence by educating its own professionals, growing the numbers of actual practitioners in any jurisdiction, fighting for the right to do so and against whatever limitations were being imposed by organized medicine or by legislation.”
Although by mid-century there had already emerged a growing consensus for the need for research in the profession, in Keating’s words, “Scholarly investigation would lay dormant for three more decades, an undernourished step-child who could not crawl.”11 Chiropractic had yet to acquire the means to embrace René Descartes’s big idea from 300 years earlier.
And then it all changed.
CHIROPRACTIC’S ANNUS MIRABILIS
Nineteen seventy-five marked a watershed year in the evolution of scientific research in chiropractic. The year witnessed a confluence of forces which crystallized at the National Institute of Neurological Diseases and Stroke (NINDS)12 conference in Bethesda, Maryland, and ultimately resulted in the emergence of a dynamic research community and a fundamental shift in the profession’s attitudes toward scientific research.13 The Feb. 2-4 conference brought together clinicians and scientists from several disciplines, including chiropractic, osteopathy and mainstream medicine. The resulting monograph, The Research Status of Spinal Manipulative Therapy, evaluated the quantitative evidence for the effectiveness of spinal manipulative therapy (SMT) and though it concluded that the “scientific validity of manual therapies had yet to be established”. . . “the importance of controlled clinical trials of manual therapies was now officially brought to the wider profession’s consciousness.”14 More fundamentally, however, the conference monograph was the first scientific treatise from a multidisciplinary perspective on manipulation resulting in a recognized authoritative text on this form of treatment. The assembly became a defining event for the science of chiropractic and one whose importance would be difficult to overstate. It had the effect of lightning-bolting the profession.
CANADA’S ROLE AT NINDS
At CMCC, there had also begun to coalesce a small cadre of academically minded individuals who started to write scientific articles and to collect data in a more systematic way, similar to what the Swiss had done. Among the foremost were Drs. Ron Gitelman, Adrian Grice and David Drum. So, when chiropractors where offered a place on the NINDS planning committee, a call went out to CMCC because it was regarded as an institution that had already established itself as a leader in the nascent years of North American chiropractic research. Consequently, three of four planning positions for chiropractors were filled by individuals from CMCC. Their presence constituted a small but significant group of core individuals with the prerequisite skills to plan and contribute to a scientific conference and their participation broke through the academic barrier.
In preparation for the NINDS conference, CMCC undertook to collect all the supporting literature on chiropractic, not all of which was written by chiropractors. Published as the Archives, it became the first extensive bibliography of the scientific literature on SMT. Abstracts were added later and published as the Chiropractic Research Abstracts Collection (CRAC). These pre-electronic-age publications were the first indexed collections of chiropractic information presaging the later development of databases such as Chirolars and Mantis.
Things began to happen quickly after Bethesda. CMCC faculty “took the initiative to establish a scholarly society, the College of Chiropractic Sciences, for the explicit purpose of preparing future chiropractors for careers in research and education. In collaboration with CMCC, the new organization established a hospital-based residency program in orthopedics at the University of Saskatchewan, and many of its graduates subsequently became productive in chiropractic research.”15
The program in Saskatchewan came about as a result of Gitelman and Grice’s efforts to form a collaboration with Dr. William Kirkaldy-Willis, head of orthopedic surgery at the University Hospital in Saskatoon – this enabled Gitelman’s associate, Dr. J.D. Cassidy, to establish a practice and work directly with hospital patients. The association with Kirkaldy-Willis was a coup. Kirkaldy-Willis was a major figure in the development of spine care and one of the few in mainstream medicine who recognized the potential of chiropractic at a time when such collaborations were rare. “Working with Kirkaldy-Willis in a university-affiliated, hospital setting, Cassidy was one of the first chiropractors to develop in a truly scientific direction,” observes Dr. Vernon. “This was a quantum leap different from what we had seen before.
Finally, we had a chiropractic researcher who looked the part.”
Dr. Vernon states that just prior to the developments in Saskatchewan, and equally important, CMCC had developed a residency program in postgraduate studies. “Residents were all required to do research. They were university educated for the most part because the transition to requiring at least two years of university experience in order to be accepted into CMCC occurred around the same time. It effectively raised the academic upper tier. We had the first budding scientific researchers as opposed to the empirical collectors of data that chiropractors had been prior to that. CMCC was hugely on the forefront of this.”
To underscore the notion of 1975 as chiropractic’s annus mirabilis, Dr. Vernon notes that it was also in this year that the first clinical trial of manipulation was published in a medical journal by a non-chiropractor. As well, CMCC held its own first research conference in the same year.
SERENDIPITY, THE SCIENTIFIC METHOD AND YOU
In Dr. Vernon’s opinion, “From the period of the 1983 conference on, research became a matter of productivity and escalating output. There was steady acceleration; no quantum leaps forward, research output just kept intensifying. All this growth is even more remarkable because this was happening in an academic environment that was not normalized. We were not in the universities and did not have access to federal funding. It was an extraordinary achievement.”
In the decades following NINDS, research in the profession has evolved to where chiropractic can begin to examine the scientific foundations of its core principles. Its philosophical foundations in notions such as vitalism, once thought by some to be incompatible with the scientific method, are being revealed as neither unscientific nor anti-science and can, in fact, feed science. (See our companion interview with Dr. Brian Budgell in this issue, page 40.) Embracing the biomedical model without compromising its philosophical roots has enabled the profession to bring the tools of the scientific method to bear on its research agenda. This, in turn, fosters a greater acceptance of the profession within the sciences, and within society generally, and is key to advancing chiropractic’s bid for cultural authority. Indeed, according to research published this year by CMCC’s Dr. Marion McGregor, it is the primary basis by which cultural authority can be gained.16
The enduring importance of the scientific method is that it gives structure to research in a way that does not depend on luck or the kind of brilliance that the world churns out only once every few hundred years. Genius aside, both Newton and Einstein employed the scientific method. The patient application of established principles of research, together with a bit of serendipity and the occasional flash of brilliance, may yet reveal the “elixir of immortality.”
Or at least another Viagra.
|The Post-NINDS Effect
After NINDS, research accelerated at different rates within the various chiropractic colleges. Some milestones of this progress:
Steve Zoltai is the collections development librarian and archivist for CMCC and is a member of the Canadian Chiropractic Historical Association. He was previously the assistant executive director of the Health Sciences Information Consortium of Toronto. He has worked for several public and private libraries and with the University of Toronto Archives. Steve comes by his interest in things historical honestly – he worked as a field archeologist for the Province of Manitoba. He can be contacted at email@example.com.
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