IN THE 1980S, I SPONSORED A FEW TRIATHLETES in New York City. I hired a graphic designer to create a logo and silk-screen for their singlets and trisuits. I called the team “String of Perles.” My practice newsletter was “Perles of Wisdom.” I figured that I should tie in my name wherever I could, and that explains, in part, the title of this ethics column. Upon reflection, the pearls are the beauty, but the string is what holds them together. The string in our profession is each individual DC, creating strength to hold the beautiful pearls of chiropractic together, and the common glue is either a strong foundational understanding of ethics or the dissolution of this bond of trust by a breach of ethics.
Ten years ago, I was sitting next to someone from NCMIC at a function at New York Chiropractic College. We had a lovely conversation that included my offhand comment that I thought that patient sign-in sheets were unethical. Keep in mind that this was before HIPAA. It just didn’t seem right to me that every patient should know who came in before them. It was suggested that I write about that for the NCMIC newsletter, The Examiner. I said, “Yeah, sure,” and just like the times we bump into friends and say “Let’s get together,” it probably wouldn’t happen.
However, on Monday morning I received an email from The Examiner’s editor requesting I write the article. OK, I was caught. I wrote the piece and sent it in. Later, I was contacted by NCMIC’s president, Louis Sportelli, DC, who believed the article needed to be sent to a broader audience and suggested Dynamic Chiropractic. And so was born ten years of some 70 ethics columns. A few years later, my arm was twisted by someone at the American Chiropractic Association and seven years and 70 ethics columns later, here I sit at the keyboard.
I know that what I’ve written is unpopular in some circles, and for that discomfort I am deeply grateful. It is only when we move from our comfort zone and know that what someone has written has made us “feel better or worse” that there is a message or a lesson to be learned. My columns on ethics have not always been popular at the University of Bridgeport College of Chiropractic either — and I don’t speak for UBCC, only for me — but my ability and fundamental privilege to be able to speak are what is important. On that note, I want to acknowledge and praise my institution for its long-term, unshakable commitment to academic freedom.
Unfortunately, I have friends who were fired from their academic jobs at other chiropractic colleges solely based upon expressing their opinions either in professional publications or in faculty meetings. In my tenure at the University of Bridgeport, the love of freedom of expression that has been ingrained in me by my fellow academics across all disciplines makes me abhor such a stifling of thought within our profession. Tenure and the principles of academic freedom are enshrined in what is known in academe as “The 1940 Statement.” In part, this is what allows academics to think in ways that may not be popular but might just advance their discipline. “The common good depends upon the free search for truth and its free exposition.” 1
As a profession, we risk having history control our future if we don’t allow dissent and dialectic without acrimony. It is only through honest debate, shared discomfort, intellectual discourse and unimpeded flow of academic challenge that a profession can survive. History must be understood and appreciated, but history cannot become the suffocating bonds that restrain or constrain the advancement of new evidence and research. My dentist and I talked about this attempt to keep chiropractic as it was. He couldn’t imagine dentistry without progress.
I find so often in discussion with colleagues via mailing lists or on Facebook groups that someone brings up some issue and my response is to send them a link to an article I wrote for either of the two publications. One hundred and forty columns is a lot, especially given that I was diagnosed with various learning disabilities in 1970. I’m sure that any of my teachers from high school through college would be shocked at this productivity, including my scientific publications, and would be beside themselves that I am a journal editor. I do not intend to make this about persevering and finding ways to deal with this disability beyond saying that the computer as a tool for writing changed my life and freed my expression in an equal and opposite degree to how a pen and ink hampered it. I do not intend to abandon my newfound freedom with keyboard and computer and refrain from writing about controversial matters. I simply want to take a short sabbatical from the grind of ethical sand that often turns into ethical “perles” using a mixture of irritation and imagination as my ingredients of choice.
I also find when writing new columns that sometimes I use the same anecdote or reference. I recently discovered two columns I wrote that were different but had an almost identical paragraph. This tells me it is time to make this “string of perles” come to an end. In the meantime, I hope you have enjoyed the ethical challenges over the past decade. It is not that we don’t know the right things to do; sometimes we simply need prodding to keep on the right course.
I hope as any author would want that some will lament my choice. I know without a doubt that some will rejoice and for those who rejoice, there will still be that knowing that perhaps somewhere those words cause discomfort for a reason. I recall an editorial by Dr. David Sackett on his decision to refrain from any discussion, writing, speaking, etc., about evidence-based practice (EBP): that sometimes experts stifle progress.2 While he was universally acknowledged as an expert in EBP, even if his recommendations were not universally used, I am not acknowledged as an ethics expert universally. Nor do I consider myself to be an expert in ethics, but rather just someone who has thought and written about ethics in chiropractic for ten years, but no more.
In closing, the words of Mahatma Gandhi ring true: “The only tyrant I accept in the world is the ‘still, small voice’ within.”
1. 1940 Statement of Principles on Academic Freedom and Tenure, American Association of University Professors. www.aaup.org/report/1940-statement-principles-academicfreedom-and-tenure.
2. Sackett DL. The sins of expertness and a proposal for redemption. BMJ. 2000 May 6;320(7244):1283.
Dr. Perle is a professor of clinical sciences at the University of Bridgeport College of Chiropractic, where he has taught an ethics course for more than 15 years. Send questions to email@example.com.