Published: 2010-08-30 01:16:26
Author: Stephen M. Perle | Dynamic Chiropractic | May 20, 2010
In their 1978 book, The Web of Belief, W.V. Quine and J. S. Ullian wrote: "The desire to be right and the desire to have been right are two desires, and the sooner we separate them the better off we are.
The desire to be right is the thirst for truth. On all accounts, both practical and theoretical, there is nothing but good to be said for it. The desire to have been right, on the other hand, is the pride that goeth before a fall. It stands in the way of our seeing we were wrong, and thus blocks the progress of our knowledge."
Saying that one was wrong in the past isn't easy for most people. Personally, I try to keep this quote from Quine and Ullian in mind. This kind of thinking is important when it comes to health care because the state of our knowledge is or should be in a constant state of flux, with new research continually providing better answers to what we should do as chiropractors.
Back in 1987, a longtime patient of mine came back to me with a new problem. When she rotated her head in either direction and did extension and lateral flexion, she got profoundly dizzy. Well, in 1987 that looked as if she had bilateral positive George's test. Although she was much older than what I'd learned was the typical age for females who had vertebral artery disorders, she had extremely high serum cholesterol when she first became my patient and she smoked cigarettes.
I recommended that she have further vascular testing, but she was resistant. The state of our knowledge back then was that I shouldn't manipulate her upper cervical spine and should order Doppler ultrasound of the vertebral artery. Nevertheless, she trusted me and wanted me to adjust her, in part because her late brother-in-law was a chiropractor and didn't trust the medical profession.
I told her she had two choices: have the test done or find another chiropractor. Reluctantly, she went to the vascular specialist I recommended, who - much to my amazement - he reported to me that she had the vertebral arteries of a baby and that, in his opinion, cervical manipulation was safe and indicated. After just two office visits of manipulating C0/C1, her "positive" George's test was normal and she felt great.
To many this would be adequate evidence that a positive George's test is indicative of the need for cervical manipulation ,but that isn't the
takeaway message. My anecdote really revealed little more than that
George's test did result in at least one false positive. In the time
since I saw this patient, research has shown us that George's test and
other similar provocative tests are actually not of value.1 As a result, chiropractic colleges have not been teaching or using
these tests, nor has the National Board of Chiropractic Examiners
included them in its examinations.