Sunday, May 13, 2018

Ethical Relativism Inside Chiropractic Education.

Education has a term called the 'Hidden Curriculum' which refers to how most individuals learn how to fit context to content. For example, what we are formally taught, what appears on the syllabus, is called the 'formal curriculum'. Clarifying questions and discussions about the material which are not strictly in the syllabus are parts of the 'Informal Curriculum'. But what is hidden carries social or behavioral context and that is learned largely via example, by watching how ones peers behave. In professional education, while students will be taught the definitions of ethics they learn how to apply ethics by observing the behavior of their seniors and, regrettably, but perhaps not unexpectedly when considering human behavior, the hidden curriculum often carries a negative connotation.

It begins early in life. We learn how to act ethically as well as the 'ethics' of 'getting away' with things, our versions of ethics. And cognition, being so wonderfully malleable, can be easily taught to consider the most appalling acts as being the most virtuous - ideologically fuelled murder, for example, is one of our species most flagrant examples of it. All professional students have reported not only witnessing unethical behavior in their more experienced peers but also admit to being subsequently more likely to repeat the behavior themselves, to become easily complicit, even though they understand it to be wrong, initially that is. This is what we simply call 'peer group pressure', the need to conform or fit in. But this elevated capacity of humans to collaborate in order to accomplish a shared goal isn't evidence of the wisdom of many group endeavours, it is a mark of evolution, that we are built primarily for survival and clustering, mobbing is one naturally selected strategy that we possess. Professionals however are expected to have the capacity to operate 'out of' the mob so to speak in order to maintain objectivity. So it is that potentially positive ability to work together which also allows us to lie, effortlessly, and in short time be almost oblivious to it. This is how dynamics such as workplace bullying or generally falling ethical standards occurs, gradually and with the consent of consensus or the mob.

A few years back I was asked to teach critical thinking in the relatively newly formed course at Central Queensland University which has a campus in Brisbane. At the time, with what I believe is a rather studied opinion of my professions strengths and considerable, ideologically driven, weaknesses, I even asked my potential bosses if they were completely sure. I even went to the trouble of quoting from a philosopher of critical thinking, the American Peter Boghossian, who once said in an interview "If no one in the room is pissed off, it's probably not critical thinking." I was then told that there will always be students who complain. I then made sure that I was precise - "I meant some of the staff."

The chiropractic profession is enamoured with our philosophical warm babies blanket, a 'totalising ideology' called vitalism, the antique belief that the reason why things live (and therefore a claim to be a (magical) theory of biology to rival natural selection) is due to a spirit or life force. In order to be as brief as I can I'll refer you to this article which, along with quite a few others, examines the manner in which children and uninformed or naive people try to explain complex biological processes. Yes, I understand that to many this sounds condescending, but it is, frankly, as rude saying that water has a wet quality and fire a certain heat. These are basic facts. We all use instinct, intuition or gut feeling, but 'naive biology' or 'vitalistic causation' is what we pretend to know when we don't actually know. And I hope, dear reader, that I don't need to explain that while it is one thing for children to not understand biology (we find it quaint), professionals are not, by any standard, expected to offer advice to the public based upon wishful thinking and intentional distortions of fact. On one particular occasion I actually stood beside a person (who had been given a full time contract (I was sessional or casual (and expendable)) who told the students that "The body is intelligently designed" which is the form vitalism comes in as espoused by religious fundamentalist groups (ie creationists who pretend to know the world is 6000 years old (and evolution a conspiracy)). This was in a neurology tutorial and my colleague had offered this 'vitalistic causation' as his explanation for why signals from the visual apparatus would be received and processed in the limbic (emotional) centres before being sent to the evolutionarily newer frontal or executive regions of the brain (those we more closely associate with thinking and reason). But not only had he completely failed to understand, he told the students he "knew" that this was true. He gave the students a version of an article of faith. At the very least he should have recognised his own limits of knowledge but it was quite opposite as I found out. Not only was his 'version' correct, no member of staff had the right to point out that students were being told false, deceptive and misleading information (and they were paying for the privilege). As another reminder here, we were not standing in a church but inside a public University while students were being taught that using a faith proposition (vitalism was superseded as a plausible science over 200 years before (when we knew almost nothing about how biology functioned)) was not only factually based but, ultimately, could be legitimately used in health care, ie it was ethically sound!

Fortunately for those students at least, they had already been educated somewhat by me. One of the main focuses of my lectures was the ethical significance of contemporary theory and practice - facts, not blind opinion, when considering matters such as the provision of objective advice to the public. I'd also mentioned vitalism, it's history, the many ways people had tried to define it, that it was a supernatural or faith assertion and that it was superseded as theory a long time ago. I even remarked that it was not 'off limits' for personal 'use' and cited drinking and sex as other activities that professionals are not supposed to confuse with their duty of care. As an aside it is, in my opinion, an awful omission in professional ethics to not state overtly that articles of faith are not in our remit. If I am a catholic surgeon, for example, it is simply not my job to replace considered opinion and robust evidence with my own subjective preference to think I know that biology is magical. That is a recipe for reputational disaster and this is precisely why claiming to be a 'vitalistic chiropractor' is unethical as well as stupendously arrogant and stupid.

Not only was vitalism never a fact, it effectively broke down our ability to think and reason. It teaches this as ethics - Don't understand something? No problem, just label gut feeling as 'congruent' with your own philosophy or worldview and it becomes fact. In other words, for a health professional to tell people that they know biology is magical or to stand by while others do, is to lie to them and my profession allows it to happen, encourages and supports it. It is to replace biological theory (all of biology is the way it is due to the process of evolution and that is driven by natural selection. These are basic facts) with 'faith thinking'. It teaches young professionals that it is their right (to vitalists, vitalism is their identity (ie Vitalistic Chiropractor)) to make things up and call it science, philosophy and professionalism. And it is none of those. A simple case in point. Even those whose self absorption and hubris overrides their own professionalism want the profession to expand. Yet they will approach this evangelically, by repeating vacuous notions of holding 'sacred trusts', 'serving' through their 'mission' and other jargon. Basically, as cults do, they think that spreading the 'Big Idea' is a matter of faith, just like the various denominations who hand out pamphlets on street corners. Of course in only 3 places has expansion actually happened. In Denmark, Ontario (Canada), and Norway, the profession has managed to break through a 100 year 10% market penetration and move into the + 20%, all achieved only one way - they officially placed 'subluxation' dogma in the past and moved forward into the real world (Vitalists tell students that they have no identity unless they too call themselves vitalists whose only 'mission' is to detect and correct vertebral subluxations (physical imperfections which are always present and which always prevent a Universal Life Force from doing it's thing. It is a cult that students are drawn into (inside Australian Public Universities). Another example is that some educators are both purveyors of evidence baseless techniques as well as controllers of what should constitute evidence based continuing professional development (CPD) on behalf of the professions main association or 'peak' body - so we have a person who is scientifically semi literate (who cannot, or does not want to, recognize what underpins 'clinical validity', despite invitations to be better educated), who operates on behalf of a body that pressures other members and educators to lower their standards to suit. As a result CPD has become almost a complete farce. I can receive 30 hours of 'Formal Learning Hours' for learning Neuro organisational technique, one of the many patchwork offshoots of Applied Kinesiology (AK) which is so bereft of validity that it is taught to moms and dads as a 'Test'. Calling or even insinuating that something is a valid test in health care means that studies have confirmed that a procedure has validity (it definitely tests a particular thing) and reliability (it is a reliable way to measure that definite process). 'Test' infers a diagnostic ability. But no study exists anywhere on this planet which finds AK to have 'construct validity'. A muscle test is clinically valid for muscle and some aspects joints and peripheral nerves. The rest of what is asserted (and what I can get my 30 hours for) is invalid as well as being put forwards as a diagnostic tool to detect difficult problems such as paediatric neurobehavioral disorders, childhood cognitive problems. Under Federal Law this can constitute neglect since it can prevent a child from receiving appropriate care. Therefore, one excuse is that practitioners of AK 'collaborate' with other health providers. Well, how would I know when to refer or co-manage if I already believe I have a test that my own profession allowed me to believe was valid? Moreover, I may well have received an education which taught me, via a not at all hidden curriculum, that 'crticial thinking' could literally be used to prove that anything was 'critcially evaluated' by labelling it as such. To vitalists, critical thinking is 'whatever I call it.'

Critical thinking is not arbitrary. We are either using it and remaining aware of a consistency of thought or we fall victim to the false dichotomy in which case we change what 'critical thinking means without missing a beat:

""The other side of chiropractic relies on a healthy nervous system and the neurophysiology thereof."

But there is no 'other side of chiropractic'. The above phrase is a political statement. Another is 'The other side of chiropractic recognizes the inborn healing ability of the body" and yet another is 'The other side understands that the body is intelligently designed.' I, and philosophers at other Universities, were unable to peck our way through the dissonance and dilemmas which are due to nothing more than a particularly insistent logical fallacy, a false dichotomy and a complete breakdown in critical thinking every time the issue of 'identity' arose. One day students were being taught critical thinking and contemporary theory and practice (what constitutes 'evidence based'), how to be responsible, outwardly looking professionals in a potentially expanding field. The next moment they are being fed the 'other side' which consisted of ideological ranting (in one case the 'philosophy' of Ayn Rand (who thought serial killers were expressing a virtue of personal objectivism (ie If I reckon it's true it is or as I logically offered one day 'It makes pedophilia just the 'other side' of love', a critical thinking example which was true but not well received (and therefore instantly perceived as an attack on identity)). Some members of the staff practice techniques which are non evidence based. The same ones attend events that recommend that a chiropractors main focus is to convince people that they need care for life, especially children, and all of this is based upon the dogma - vitalism. Yet the course is advertised as 'evidence based'. If you bring these simple facts up, as one is expected to do inside a University, it is perceived as a personal attack. It's as if we were inside a creche. I sat in meetings and listened to people who did not know and did not care to know why definitions and precision were important in education, who became red faced by reality, insulted that they should, as educators, be better educated, puzzled as to why it was problematic for an educator to use faith as an epistemology (pure 'it's a miracle' guesswork as a method for determining what constitutes knowledge). This is the so called 'other side'. The only thing that could be said for the experience was that I am unlikely to ever again witness such egregious philosophical ducking and weaving and ethical relativism inside a Tertiary institution ever again, at least I hope so. I would also write nothing were it not for that fact that if I do not, the result is the production of another generation of 'innocent' frauds. An educator (my first profession) cannot simply cannot watch a university be used as an effective platform to target people for indoctrination. In this article the author points out what should be all too obvious - belief is not knowledge and we have no right to ignore the truth of this statement. The 'healthy nervous system' that the 'other side' is apparently more aware of and which my colleague refers to is the very thing that generates this considerable bias, yet I was not supposed to point this out?!

"'Who are you to tell me what to believe?' replies the zealot. It is a misguided challenge: it implies that certifying one's beliefs is a matter of someone's authority. It ignores the role of reality. Believing has what philosophers call 'mind-to-world direction of fit'. Our beliefs are intended to reflect the real world - and it is on this point that beliefs can go haywire. There are irresponsible beliefs; more precisely, there are beliefs that are acquired and retained in an irresponsible way. One might disregard evidence; accept gossip; rumour, or testimony from dubious sources; ignore coherence with one's other beliefs; embrace wishful thinking; or display a predilection for conspiracy theories..." 

This is where the hidden curriculum comes in - it isn't even hidden in the chiropractic profession, it is overt, formal or informal and the gates are held open by many of the educators themselves because they have learned how to collaborate inside the chiropractic system, through negotiating their ethics. They are actually victims of our own hidden curriculum, the very thing I was asked to warn them against. In order to make myself transparent, as a professional should, I'd tried to invite my boss to a meeting with the philosopher who runs the Critical Thinking Project at the University of Queensland. If they wanted critical thinking they needed to know what it was. Finally, after many cancelled attempts, four of us met. Within 5 minutes my mentor had deconstructed the courses dilemma. Politics, associations and technique merchants do not write the content of University courses and yet this was precisely the pressure put to bear by what was a massive conflict of interest driven by an 'identity politic' who insist that everyone be as poorly informed as they are or agree to ignore the significant problems of doing so. That is what my profession does. Like all other groups which harbour totalising ideologies (its members are right and valid by being members of it), we nurture conspiracy theorism. Such paranoia means that we expend a great deal of effort in keeping group standards as low as possible. Educators who wish to raise standards are expected to lower theirs. It is, quite simply, a disgrace.

Around 20% of the profession are 'traditionalists', people who consider chiropractic to be a quasi religion and therefore whose only weapon is political pressure. To add, many of those who hold education roles have also sat on the executive of the very associations controlled by traditionalists and their need to distort professional ethics with their 'identity.' It's a US style model, quite the amplified version of the normal levels of corruption and graft we tend to expect from ourselves. In the US, a remarkably religiously fundamentalist nation, it is an individual right not only to have your own opinion but have your own facts as well. So in this case my mentor at another institution, in the words of my boss, "Didn't understand" and, of course, what the philosopher actually did was understand entirely what our profession is like and all in under a few minutes. I felt like I'd just left a failed therapy session with my own profession. Diagnosis - denial. Chiropractic education in Australia is corrupt in principle due to our decision to abandon the very principle of ethics itself in preference to placating one 'identity' which is not even professional in nature. As a result we do ethics 'bare bones'. If you didn't have sex with, or rob, a patient, the decision as to what encompasses 'ethics' is what appeals to you personally. I once called it intellectual masturbation in a tutorial and received one complaint. The reason I used it is because I understand cognition a little. Humans are animals who depend upon rapid reflexive reactions to novel sensory stimuli. The term 'Intellectual Masturbation' attracts attention as well as being a wonderfully succinct metaphor for the cognitive bias itself, for our ability to get things wrong. It's one of the many effective ways of reflecting wisely on life and behaviour. I'd do students a disservice not to give them an effective means of understanding their own, and others, natural proclivity to spout utter nonsense. So who am I to apologise for needing to heed the begrudging voices as I pull people into the present and away from a 100 year old dogmatic legacy? We are not a church. Then why act like one?

Here's how you think about a complex biological problem - don't pretend you know then use contemporary theory. If messages went to the executive regions first it might mean better cognition but we'd be slow and very dead in the process (the lower regions of the brain are 'self processing' ie you do not need to think for them to act. Vitalists interpret this as 'intelligence' but how intelligent is it when we consider how faulty it is?). Evolution has no 'choice' but to select survivors therefore a more rapid system would be selected, hence all sensory stimuli is processed 'sub' cortically. We can think well and be knowledgeable but it is not something that comes via gut feeling and rhetoric. We are not born just tabula rasa, like a blank slate ready to be filled with wisdom, but we are actually born credulous with an array of automatic reflexes and many of us proceed no further. As a profession we want to be considered 'evidence based' but only if the 'other side' can use the same term and then proceed to re imagine or manufacture what evidence actually means. We are like self harmers, perhaps masochists, who might think that all their troubles lay outside of themselves but whose only tactic is to rent their own flesh. These same people on the 'other side' are committed to an ocean of dysfunctions - antiintellectualism, ethical slipperiness, self absorption, credulity, paranoia and perhaps the worst, rabid antivaccinationism. It was only a short while ago that our peak body was directly responsible for importing actual frauds to help 'educate' us all. Chiropractors, many of them paid up members of the then Anti vaccination group the AVN as well as the Chiropractors Association (including the executive) of Australia were involved. That level of corruption has not just evaporated, not even gone underground, but is now seeking to build a vitalist college in South Australia. And the body responsible for accrediting the courses also has a new face - the previous head of discipline at Central Queensland University (CQU) who believes that evidence based practice and critical thought involve varieties of what constitutes evidence, and a type of thought so fractured by ethical relativism that I wonder what the future will bring for this profession. Students were like sponges in my brief time at CQU, not only able but willing to learn that critical thinking and professionalism were far greater prizes than shallow allegiances to tradition and factions bent on stagnation. But without that type of education, an honest, evidence informed, contemporary and openly ethical and transparent one, free from political identities, the future looks decidedly dark.


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