In response to "The Knowledge of Our Knowledge": a reflection on McAndrews' view of epistemology.

This commentary considers one of the articles published in the first volume of this journal and reflects on the status of research and knowledge at that time. The chiropractic profession has witnessed advancement in the use of the scientific method in the past several decades, and scholarly journals have helped support this substantial growth.

Discussion

The National University of Health Sciences began publishing the Journal of Manipulative and Physiological Therapeutics in 1978; and since that time, this peer-reviewed journal has provided the chiropractic profession with much needed scientific articles relating to the science of chiropractic medicine. However, after the birth of the Journal of Manipulative and Physiological Therapeutics, it was my opinion that our profession also needed a peer-reviewed journal dedicated to articles on the philosophy of chiropractic. Thus, the journal Philosophical Constructs for the Chiropractic Profession (Fig 1) was born, which would evolve to become the Journal of Chiropractic Humanities. During the development of this new journal, I wanted the first volume to be especially useful as it would relate to the philosophy of chiropractic.

Fig 1

First cover of Philosophical Constructs for the Chiropractic Profession that would later be named the Journal of Chiropractic Humanities.

As a self-educated student of the term philosophy, I had come to appreciate a different perspective on the “study and love of wisdom” (eg, the basic definition of the term philosophy). It was my intention to make a clear statement to our alumni and others through a conference on philosophical constructs and the journal that the National College of Chiropractic intended to take a strong position in the development of professional tenets and in the process of working toward defining the chiropractic profession in modern and acceptable terms. Therefore, I decided to hold a special set of presentations on these topics, which would then generate a foundational set of articles for the new journal. I invited authors to present and write about the major pillars of philosophy, namely, epistemology, ethics, logic, metaphysics, and esthetics. Each paper would then be presented at the annual Homecoming of National College of Chiropractic in 1990 and subsequently published in the charter edition of the new journal.

Dr Jerry McAndrews was one of the presenters who I invited to participate in this event. It was my personal privilege to have known and worked with Dr McAndrews during the period when he served as Director of Development at what was then named the National College of Chiropractic. Dr McAndrews possessed an inquisitive mind so would be ideal as a speaker for the first meeting. I felt that his perspective would be particularly important, as he had previously been the Executive Director of the International Chiropractor's Association and President of Palmer College of Chiropractic—both organizations that often used the term philosophy when referring to the chiropractic profession and the practice of chiropractic. When I asked him to author an article for the new journal Philosophical Constructs for the Chiropractic Profession, he readily agreed.

When he crafted the title “The Knowledge of Our Knowledge,” it was clear to me that he was choosing to write about epistemology—how we know what we know and what objective methods underscore our professional beliefs. This was a relevant topic in the late 1980s and early 1990s because the development of modern scientific research for the chiropractic profession was still in its infancy. At this stage of development, there was little institutional commitment to scientific research. The National College of Chiropractic was one of the first institutions that had dedicated substantial space and personnel to scientific research. The first research grant that was substantial and meaningful was provided by the Foundation for Chiropractic Education and Research in the amount of US $1.1 million (nearly US $2 million in today's dollars) and was granted to the National College of Chiropractic. This research center was the chiropractic profession's first comprehensive clinical research center.

The research center was named the Practice Consultant's Clinical Research Center as a tribute to William Harris, DC, who provided the Foundation for Chiropractic Education and Research with the funds. Patricia Brennan, PhD, was the Dean of Research at National College at the time and her colleagues included Jay Triano, MA, DC; Darryl Daley, PhD; Dennis Skoggsbergh, DC; Marion McGregor, DC, MSc; James Christiansen, PhD; Maria Hondras, Bs, DC; James Baker, DC; and Gregory Cramer, DC, PhD, among others. Studies that resulted from this initial center development included articles in Fig 2. Therefore, it was a perfect time for McAndrews to write about epistemology.

Fig 2

Examples of articles published from the first comprehensive clinical research center in the chiropractic profession

Brennan PC, Triano JJ, McGregor M, Kokjohn K, Hondras MA, Brennan DC. Enhanced neutrophil respiratory burst as a biological marker for manipulation forces: duration of the effect and association with substance P and tumor necrosis factor. J Manipulative Physiol Ther. 1992 Feb;15(2):83-89.

Brennan PC, Kokjohn K, Kaltinger CJ, Lohr GE, Glendening C, Hondras MA, McGregor M, Triano JJ. Enhanced phagocytic cell respiratory burst induced by spinal manipulation: potential role of substance P. J Manipulative Physiol Ther. 1991 Sep;14(7):399-408.

Church CP, Buehler MT. Radiographic evaluation of the corporotransverse ligament at the L5 intervertebral foramen: a cadaveric study. J Manipulative Physiol Ther. 1991 May;14(4):240-248.

Triano J. Skin accelerometer displacement and relative bone movement of adjacent vertebrae in response to chiropractic percussion thrusts. J Manipulative Physiol Ther. 1989 Oct;12(5):406-411.

Kokjohn K, Schmid DM, Triano JJ, Brennan PC. The effect of spinal manipulation on pain and prostaglandin levels in women with primary dysmenorrhea. J Manipulative Physiol Ther. 1992 Jun;15(5):279-285.

Brennan PC, Graham MA, Triano JJ, Hondras MA, Anderson RJ. Lymphocyte profiles in patients with chronic low back pain enrolled in a clinical trial. J Manipulative Physiol Ther. 1994 May;17(4):219-227.

Dr McAndrews and I often discussed philosophy and the way the term was used in the profession. We discussed the concepts taught within the chiropractic colleges in relationship to the fundamental ideas that chiropractors shared about how the human body functioned. On one occasion, he related to me that he had attended a conference at which the speaker was discussing the neurophysiology of the synapse—the idea that there was no direct physical connection but rather a chemical one. During the conference, McAndrews overheard one chiropractor say to the other, “I don't care what they say, I KNOW those things have to be touching in there somewhere!” He was amused but at the same time disappointed in the lack of educational sophistication of his fellow chiropractors. This may have inspired him to describe the emerging understanding within the profession when he stated, “the inadequacies of the ‘chiropractic philosophy’ have been directly proportional to the lack of meaningful scientific data to explain the who, what, where, how and why of chiropractic health care.”

More than 110 years earlier, Charles Peirce, an American philosopher who lived from 1839 to 1914, wrote his treatise “The Fixation of Belief” in 1877. He wrote, “The object of reasoning is to find out, from the consideration of what we already know, something else which we do not know. Consequently, reasoning is good if it be such as to give the true conclusion from true premises and not otherwise. Thus, the question of validity is purely one of fact and not of thinking.” Peirce outlines the “methods of fixing belief” that people use, including the following: The Method of Tenacity (I know this is true because I believe it to be the truth; therefore, it must be true!); The Method of Authority (I know this is true because the accepted authority says it is true; therefore, it must be true.); The a priori Method (I know this is true because it “stands to reason”; therefore, it must be true.); The Method of Science (There are real things whose characters are entirely independent of our opinions about them, and these can be determined by methods outside of my ability to affect them.).

In the article “The Knowledge of Our Knowledge,” the reader is led to a better understanding of the need for the chiropractic profession to embrace the scientific paradigm as its method of “fixing belief” for the what, why, and how of chiropractic practice. Written more than 20 years ago, this article was instrumental in “setting a new course” of inquiry for the chiropractic profession—scientific research. It built upon the writings of individuals such as clinician scholar CO Watkins, DC, who wrote, “No doubt, the cultist attitude of many early chiropractic leaders, the failure of early chiropractic government to establish a scientific organization to scientifically test and advance chiropractic methods and the failure of our colleges to properly orient the student in the field of science are responsible to a great degree for the relatively large number of cultists in chiropractic.”

Since this article was published in 1991, the chiropractic profession has witnessed significant advancement in the use of the scientific method as a way of gaining “knowledge of our knowledge”; and much of it has been recorded in the pages of the Journal of Chiropractic Humanities, the Journal of Chiropractic Medicine, and the Journal of Manipulative and Physiological Therapeutics.

For me, the publication of Philosophic Constructs for the Chiropractic Profession (now the Journal of Chiropractic Humanities) with its original articles discussing the subject of philosophy and its applications to the chiropractic profession represents a seminal event for National University of Health Sciences and, through its history of publication, for the profession as well. This article by Dr McAndrews and others included in the initial volume of this journal focused a clear light of introspection on the significance of philosophy to the profession and to the tenets derived from its philosophic underpinnings.

Funding sources and potential conflicts of interest

No funding sources were reported for this article. The author is the President of the National University of Health Sciences, owner of the Journal of Chiropractic Humanities.