Essential Principles of Chiropractic

ESSENTIAL PRINCIPLES OF CHIROPRACTIC

Philosophy

ESSENTIAL PRINCIPLES OF CHIROPRACTIC

Virgil V. Strang, D.C., H.C.D. (Hon.) Dean of Philosophy & Director of Professional Ethics

Philosophy

Palmer College of Chiropractic DAVENPORT

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ACKNOWLEDGMENTS I wish to thank the following individuals for their cooperation and assistance in preparing this book: WILLIAM McDONALD, B.S., D.C. - CONTRIBUTING EDITOR Natalie Burrows, B.S. - Manuscript editor Gregory Borror, B.A., D.C. - Index compilation Douglas Payne, D.C. - Resource material Fred Barge, D.C. - X-rays Burl Pettibon, D.C. - X-rays Glenn Stillwagon, D.C. - X-rays

Copyright C 1984 Virgil V. Strang All rights reserved. No part of this publication may be reproduc� or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission of the copyright holder.

Second Printing First Edition January, 1985

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"The French critic, Remy de Gourmont, observed that 'very simple ideas are within the reach of very complicated minds only. ' This is especially true of philosophy. "

E.W.F Tomlin The Western Philosophers

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CONTENTS

-V� Acknowledgments

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Foreword

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Chapter One THE PURPOSE of CHIROPRACTIC PHILOSOPHY

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Chapter Two THE NATURE OF HEALTH & DISEASE

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Chapter Three THE SCIENTIFIC BASIS of CHIROPRACTIC

42

Chapter Four THE CLINICAL RESULTS of CHIROPRACTIC

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Chapter Five THE CHIROPRACTIC APPROACH TO PATIENT 90

CARE Chapter Six PROFESSIONAL & ETHICAL CONCERNS

118

Chapter Seven BEYOND THE SUBLUXATION

146

Appendixes

SELECTED QUOTATIONS of D.O. PALMER A THOUGHT ON HOMEOSTASIS Index

155 166 167

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FOREWORD

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Whenever the word chiropractic is mentioned, an observer would most frequently hear the words D. D. Palmer, Palmer College of Chiropractic and Davenport, Iowa, as well. This association of a pro­ fession, a person, an institution and a community is, of course, not coincidental but is a direct outgrowth of the facts of history. From time to time over the decades since chiropractic was discovered in 1895, books have been authored at Palmer College and elsewhere which contribute to the informational fabric of our pro­ fession. They address many aspects of the chiropractic concept and the development of the philosophy, science and art of this youngest member of the healing arts. Our history has sometimes had stormy episodes, but always our growth and development have been in a positive direction. During a significant portion of the approximately ninety years of our existence, the author of this particular effort has been appropriately classified as an anatomist, a chiropractic philosopher, a practitioner and as a spokesman for professional ethics. Dr. Virgil Strang, a friend and a colleague, is widely known for his views on health in general and chiropractic in particular. He always has seemed to perceive health in terms of its broadest possible meaning and, therefore, has en­ visioned for his students and others a great role for our profession. Dr. Strang, in my opinion, has personified the grasping of the "big idea;" and I feel we are fortunate, indeed, to have his contribution in these pages which comprise the most extensive book on chiropractic philosophy to be published in over fifty years. It is only appropriate that a thirty-three year member of the faculty of Palmer College be the author of this effort. He has been actively involved during both the storm and the calm. I believe everyone associated with chiroprac­ tic, as well as everyone searching for or wishing to maintain their health, should find much food for thought in this book. Jerome F. McAndrews, D.C. President Palmer College of Chiropractic

n THE PURPOSE OF CHIROPRACTIC PHILOSOPHY

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The Purpose of Chiropractic Philosophy

B oth medicine and chiropractic can trace their lineage

to Hip- """"'"

pocrates, the celebrated Greek physician of 400 B. C. l While both professions still retain elements of his philosophy and teachings, the truth is Hippocrates' medications and manipulations lacked the distinc­ tive modus operandi inherent in the practice of contemporary medicine and chiropractic. The birth of medicine as we know it occurred in 1860 when Robert Koch postulated the germ theory. Chiropractic made its real start in 1895 when D. D. Palmer went beyond crude manipulation, boneset­ ting, traction and massage by introducing the specific, short-lever vertebral adjustment. The impact of these developments was profound. In a relatively short time, both professions had been so thoroughly seduced by their new therapeutic concepts that members in both groups openly issued lofty predictions and claims. While giving lip service to the importance of preventive health care, the medical profession put most of its eggs in the germ-theory basket. Microbes were the great cause of disease. Nutritious diet, adequate rest, clean air and water, regular exercise, proper posture and the alleviation of stressful living were of little clinical import. The patient became passive as the doctor became active. The patient was the innocent victim of a "bug"; it was up to the physician to find it and kill it. The German physician Emile von Behring typified many medical doctors who felt, in the words of Rene Dubos, that "all important infections would eventually be controlled by the use of therapeutic serums and prophylactic vaccines specific for each and every type of microbe. "2 Not to be outdone, B. J. Palmer, son of D. O. Palmer (chiroprac­ tic's founder), proclaimed unqualifiedly that the vertebral subluxa­ tion was "the cause of all disease. " The cure, of course, was the chiropractic adjustment. To most early chiropractors, practically all disease was the result of an encumbered nervous system which, in turn, was due to slight misalignments, protrusions and occlusions of the spinal column. Enamored with their clinical results, chiroprac­ tors also went through a period when they played down the patient's need to follow a well-balanced health regimen. The success of medicine and chiropractic put tremendous pressure

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The Purpose of Chiropractic Philosophy on the other three turn-of-the-century health care professions. The naturopaths eventually lost out to the chiropractors,

and the

homeopaths fell in the wake of medicine. Osteopathy, with its roots in medicine, slowly returned to the fold; today, most osteopaths are indistinguishable from medical doctors. Though this is not meant to be a history book, it is impossible to pursue chiropractic philosophy to any length without taking note of certain early developments within the profession. It was almost in­ evitable that the absolutist dictum of "one cause-one cure" could not be made to stick. In addition to the M. D. 's who took up chiroprac­ tic, there were others3 in the profession who did not accept the theory that the vertebral subluxation was the sole cause of disease; even­ tually their position would carry the day. It followed that without the theory of singular cause, there could hardly be a singular cure. The resolution of this issue did not, however, bring calm to the chiropractic profession. The old political and philosophical groupings of broad­ and limited-scope chiropractors (the so-called "mixers" and "straights") have continued to skirmish, primarily over the question of what con­ stitutes the chiropractor's proper scope of clinical services. Nowhere are the old battle scars more evident than in the doc­ trinaire language used by the two factions: chiropractor vs. chiropractic physician; subluxation vs. fixation or lesion; innate intelligence vs. nature or homeostasis; analysis vs. diagnosis; and adjustment vs. manipulative therapy. These are some of the time-worn watch-words that have sparked many an argument. Because of this fact, this book will subscribe to neither vocabulary. For example, at times "innate intelligence" will be used, at other times "nature" or "homeostasis' � .' will be used. If the basic chiropractic principle exists, then words or' terminology can not change it. D. D. Palmer, B. J. Palmer, Willard Carver, John Howard, or A. L. Foster, to name a few early leaders, did not manufacture chiropractic. They simply recognized the ex­ istence of it and spent their lives trying to better understand it. For example, several times B. J. Palmer made radical changes in his think­ ing and practice (meric system, x-ray, neurocalometer, hole-in-one, and then a re-embracement of full-spine adjusting). He wrote, "I have been a constant research student, seeking further light in newer and better explanations of solutions of unknown problems hidden in our new science." The early leaders in chiropractic never allowed their

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The Purpose of Chiropractic Philosophy thinking to become fossilized. So, by de-emphasizing reactionary,

\

polemic terminology of various camps, it is hoped that attention can be focused on the main themes of chiropractic.

As a result of the events of the past 100 years, today's health care consumer is faced with two very different practitioners. The medical doctor, steeped in allopathic4 philosophy, and the chiropractor, guided by the tenets of chiropractic philosophy, offer themselves to a sometimes bewildered public. How can two physicians study the same textbooks for four years, peer through microscopes at the same microbes, and dissect similar cadavers, only to come to such different conclusions as to the nature of health and disease? The answer is found in the particular facts which the two choose to emphasize and in the patterns in which those facts are then arranged. For example, homeostasis and secondary drug resistance are two scientific concepts which, to the chiropractor's mind, provide support for a more cautious, limited use of chemotherapy. It is this activity - the piecing together of facts from the unending encyclopedia of scientific and clinical knowledge - that is the func­ tion of chiropractic philosophy. In short, chiropractic philosophy is concerned with explaining in highly specific terms the art and science of chiropractic. That explanation includes what the chiropractor does and why. Chiropractic philosophy has long been stressed by the chiroprac­ tic profession as a matter of survival. When it comes to making deci­ sions about health and disease, the vast majority of individuals automatically think in terms of traditional allopathic philosophy. Disease to most lay people seems a "thing" that comes from outside the body and "strikes" or "invades" for no recognizable reason; in fact, we frequently hear individuals say that they have been "lucky" not to have contracted a particular disease. Given the above medical model as a common reference point in our culture, chiropractic can not and does not "make sense." Only once the patient understands the "chiropractic model" can the doc­ tor of chiropractic function under optimum conditions. In fact, medical researchers at the University of Utah have found that the chiroprac-

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The Purpose of Chiropractic Philosophy tor's effort to make chiropractic understandable to the patient con­ tributes to effective therapy.5 Not only must chiropractors and their patients have a grasp of chiropractic philosophy, but so must a wider portion of the general population. Many individuals who could benefit from chiropractic ser­ vices have not done so because they viewed the chiropractor through allopathic lenses: "I need something for my asthma - not my back adjusted. " Fortunately, chiropractic is becoming better understood by both the general public and the medical community. Patient refer­ rals to chiropractors by M. D. 's have risen sharply in recent years; in fact, the number of medical physicians who themselves receive chiropractic care seems to be on the increase. The ensuing pages, in addition to providing an explanation of chiropractic, deliniate and underscore those tenets and principles which are considered essential to the chiropractic profession. Where major questions and long-standing points of contention exist within the profession, an attempt is made to suggest answers and solutions. The proposals in these specific situations are made with the hope of fostering unity within the profession while maintaining a consistency to our philosophy. It must be mentioned that chiropractic philosophy, like classic philosophy, should not be chiseled in stone. It must be alive, ever ready to accommodate new, relevant discoveries in science. As the 20th century philosopher C. E. M. Joad wrote, "In philosophy, then, as in daily life, cocksureness is a function of ignorance. "6

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The Purpose of Chiropractic Philosophy

CHAPTER ONE FOOTNOTES ISchafer, ed. , Chiropractic Health Care, 3rd ed. (Washington, D. C. : Foundation for Chiropractic Education and Research, 1978), p. 14. 2Rene Dubos, Mirage of Health (New York: Harper and Row, 1959), p. 152. 30.0. Palmer, The Science, Art and Philosophy of Chiropractic (Portland, Ore. : Portland Printing House Co. , 1910), pp. 75 and 100. For example: Willard Carver, president of several early chiropractic schools, argued that "suggestions" should be considered a cause of disease. Even D. O. Palmer, chiropractic's founder, be­ lieved that the vertebral subluxation was the cause of only 95 per­ cent of the diseases, with the other five percent being due to articular derangements elsewhere in the skeleton. 4� ohn Friel, Dorland's Illustrated Medical Dictionary,

26th ed.

(Philadelphia: Saunders, 1981), p. 50. The allopathic physician seeks to produce a condition incompatible with the condition to be cured. SKane, et al., "Manipulating the Patient

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A Comparison of the Ef­

fectiveness of Physicians and Chiropractic Care, " The Lancet (June 29, 1974), p. 1336 as quoted in Schafer, op. cit. , p. 93. 6C.E.M. Joad, Philosophy, 3rd, ed. (New York: Fawcett World Library, 1966), p. 10.

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� THE NATURE OF HEALTH AND DISEASE

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The Nature of Health and Disease NOTE TO THE READER: The purpose of this chapter is to examine the distinctions that exist between chiiropractic and medical thinking regarding the concepts of health and disease. Because we seek to delineate differences, this chapter is purposefully polemic and pointed in its observations of medicine's philosophical and practical shortcom­ ings. At no time, however, do we want the reader to think that we are proposing that chiropractic is a substitute for medicine. It is foolish for either discipline to attempt to supercede the strengths of the other. No single healing art can boast of having all the solutions to the myriad ailments besetting mankind.

D

orland's Illustrated Medical Dictionary defines health as "a state of optimal physical, mental, and social well-being, and not merely the absence of disease and infirmitx . " Dorland's defines disease as i1 any deviation from or interruption of the normal structure or func­ tion of any part, organ, or system (or combination thereof) of the body that is manifested by a ch aracteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown . " Several observations about the above definitions are in order. While this medical definition of health does succeed in broadening the con­ cept by including "mental and social" aspects, it fails to clearly break with the notion that health is s ther than the "absence of disease . " To say that health i "well-being' (literally being well) is to add little to our understanding of t e concept . Even the modifier "op­ timal" does not make well-being take on any new meaning; it sim­ ply emphasizes that the person is well, as in the expression "very well." In short, this updated medical definition fails to offer a convincing blow to the old notion that health is the absence of disease . Actually, this erroneous view - that health is the absence of disease - meshes perfectly with the way medicine is practiced . Consider for a moment the traditional allopathic doctor-patient relationship . In keeping with the philosophy of allopathy, the doctor seeks to establish conditions within the patient which are incompatible with or antagonistic to the disease . The suspected causative agent is to be driven out, so to speak, by subjecting it to oppressive conditions (e .g., subjecting a streptococcal infection to streptomycin) . Throughout the "battle ," both the doctor and patient adhere to certain tacit assump17

The Nature of Health and Disease tions: 1 ) that the body works like a machine (bioengineering and biomechanics are two representative "buzz" words) , 2) that the disease usually occurs because the body has been overpowered by one or more environmental factors (microorganisms, toxins, etc . ) , 3) that disease is an entity , and as such , it should be the focus of the doc­ tor's attention and ministrations, and 4) that upon banishment of the disease , the patient's health will have been restored . Remember, we are not talking about what the doctor professes to believe , but what the doctor does in the clinic . In practice , allopathy has stressed the importance of the external environment, and in doing so, has failed not only to take into ac­ count the body's ever-changing, adaptive internal environment, but also to fully appreciate the crucial interrelationsr.:ps between those two environments . As a result, allopathy uses as its work-a-day reference, a conceptualization of the human organism which is devoid of any meaningful role for what anatomists and physiologists con­ tend is the essential feature of our biological makeup : homeostasis . When confronted with this charge, medicine issues an emphatic denial , citing both literature and specific diseases where physicians do take into account the body's natural homeostatic mechanisms in ridding the patient of disease . But these evidences are misleading. In the end , medicine must be judged by the customary clinical picture it presents . Too many physicians, for too many years have treated too many symptoms in­ stead of causes. This fact testifies to the allopath's general disregard for the role of homeostasis . The body can and will rid itself of most symptoms, provided the cause is removed . � lIopaths regularly give medications for the express purpose of depressing body temperature . The Merck Manual of Medicine reminds physicians that "Treatment of fever must be directed to its cause . " But instead of addressing the cause of the rising temperatur� the 'L physician too often impulsively treats the symptom - the feve& ain suppression is another prime example of the allopathic tendency to focus on symptoms . It is one thing to offer pain suppressing drugs to a dying 85 year old; it is quite different to administer pain killers to a 20 year old who has fallen on his sacrum . The latter needs to have the irritation and pain removed by a corrective adjustment, not masked by a depressant . The use of corticosteroids is another ex-

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The Nature of Health and Disease ample from the unending list of symptom treatments used by modern­ day allopaths. Corticosteroids do not attempt to get at the cause of inflammation , and, like many medications, there are serious side ef­ fects which can accompany their use . Typical of allopathic thinking is this statement from a medical text: "The rationale for corticosteroid use is that it provides a mechanism which will reverse the inflammatory response and hopefully avoid neural fibrosis. " Why eliminate the inflammatory response? It is not the real problem . The inflammatory response is only a symptom of a deeper problem . Furthermore , why is the emphasis in medicine so one-sidedly on finding a new treatment? Why not a similar in­ terest in finding out how we can keep people from getting inflamed joints. Chiropract'o¥s , some osteopaths, and to a limited extent den­ tists and podiatrists more fully appreciate and utilize preventive health care measures . What is at the very bottom of the philosophical and clinical dispute between chiropractors and allopaths? What is the major point which causes the two professions to diverge? It is this: iropractic views the human being as being continually in flux along a biologic con­ tinuum . Both philosophically and clinically, chir ractic rejects the common notion that a person is either sick or w The adage , "An apple-a-day keeps the doctor away, " shows that we have learned to associate the physician with disease care , not health care . Why? Because the typical practicing physician treats disease after it has made its appearance . Why does the physician treat disease afterwards, but not before it develops? Two reasons. First, patients often wait long after they should before seeking help . But secondly, and most importantly, allopathy is shackled by the belief that a human being is either sick or well . As we noted earlier, their definitions of health and disease do not escape this conclusion . Despite physicians' arguments to the contrary , when we observe them in practice, they give ample evidence that they do believe that people are either sick or well. What would happen if you asked a physician for erythromycin when you were not infected? The doctor would , of course , refuse your request . The same if you asked to have a cast placed on your arm and your arm was not broken . Likewise, if you asked to be placed in traction but your back was not hurting . These examples are not intended to imply that the physician should treat these patients . The

E.h

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The Nature of Health and Disease object is to call attention to the fact that the physician, by training, philosophy and particularly by armamentarium , is prepared to treat any patient provided the patient has specific signs and symptoms of a specific disease . In short, you must be sick to get "health care . " e chiropractor, o n the other hand , is desirous of seeing the pa­ tient early in the degenerative process, preferably before symptoms arise . The chiropractor is not looking to treat disease . The chiropractor is looking for interference to the nervous system , a condition which can be cared for before the patient begins to experience serious symp­ toms and disease .

lfh

The chiropractor has a fundamentally different way of assessing a person's condition relative to health and disease . The following is an explanation of the chiropractic approach to assessing the in­ dividual's ever-changing physiological status. This chiropractic con­ struct can be called State of the Organism. "State of the organism" js used instead of "state of health" because the latter carries with it two problems: 1 ) since "health" tends to be thought of in the tradi­ tional and erroneous view1:hat health is the absence of disease!. "state of health" tends to be viewed as simply the degree to which disease is absent, and 2) "state of health" reflects in its syntax and t:ommon usage the attitude that health is an entity and that health (and disease) are visitors who willy-nilly come and go . The implication is that the body is merely a motel which suffers the damages or reaps the prof­ its from these two travelers. State of the organism , on the other hand, is a term which focuses on the amic state of the body as it operates along a biological continuum . �ate of the organism consists of three aspects: 1) the biological spectrum , 2) the state of the organism equa­ tion, and 3) the calisthenic dynamf

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THE BIOLOGICAL SPECTRUM. The human being functions within a biological continuum which extends from what might be called "ideal functional wellness" at one end to "death" at the other end . It is im­ portant that this concept be given full realization in clinical practice . Otherwise, patients are viewed as just sick or well , with little atten­ tion given to that portion of the spectrum between the extremes. In reality, the patient passes through a continuum on the way to ex­ pressing disease . From "ideal functional wellness, " the organism moves to a status which may be termed "departure from wellness , " 20

The Nature of Health and Disease

then to "dis-ease" (lack of ease , coordination , or adaptation) and on to the expression of a specific "disease , " complete with the signs and symptoms which give the particular disease its name . It must be remembered that the organism is continually in flux along the biological spectrum . So not only do we want to know where the patient is on the spectrum at a given time, but we want to know in which direction the state of the organism is moving. Properly seen , a symptom tells us only that change is taking place; it does not tell us in which direction . The direction can be determined only by further evaluation . Given the perspective of the biological spectrum , we begin to put signs, symptoms and disease into their proper place . Instead of see­ ing individuals as being either sick or well , we begin to see them as being in flux, usually somewhere between "ideal functional wellness" and "disease . " We begin to see a need for state of the organism care - not health care (which in our society is disease care) . We begin to see the need for care that addresses patients precisely at their posi­ tion and direction of movement on the biological spectrum . We begin to see that traditional disease care meets the needs of only a small proportion of the population . Disease care has little to offer those millions of individuals who are somewhere between the extremes of "ideal functional wellness" and "disease ." As Joseph Janse, longtime president of National College of Chiropractic, once observed:

LYnless pathology is demonstrable under the microscope,

as in the laboratory or by roentgenograms , to them [al­ lopaths] it does not exist . For years the progressive minds in chiropractic have pointed out this deficiency. With em­ phasis\ fuey [chiropractors] have maintained the fact that prevention is so much more effective than attempts at a cure ! They pioneered the all-important principle that ef­ fective eradication of disease is accomplished only when it is in its functional (beginning) phase rather than its organic (terminal) stage . It has been their contention that in general the doctor, the therapist and the clinician have failed to realize exactly what is meant by disease processes, and have been satisfied to consider damaged organs as disease, and to think in terms of sick organs and not in terms of

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The Nature of Health and Disease sick people. In other words, we have failed to contrast disease with health, and to trace the gradual deteriora­ tion along the downward path, believing almost that mild departures from the physiological normal were of little con­ sequence, until they were replaced by pathological changes...

1.:j

STA TE OF THE ORGANISM EQUATION. In a simple mathematics equation such as x·y= 10, the interacting factors (x·y) form an equilibrium with the resultant (10) . Two examples of this equation would be 2·5=10 or 10·1=10. It is possible to use this elementary equation to approximate the general interrelationship that exists be­ tween the body's external and internal environments. As is commonly known, the body normally maintains an internal temperature of 98.6° F despite ups and downs in the temperature of the environment. This important physiological fact can be represented by the equation Te ·Oi=98.6°F, wherein Te is external temperature and 0i is inter­ nal dynamics (not internal temperature). For example, when Te is 100°F we find that 0i must assume an adjustment factor of only,.986 in order to maintain the normal internal temperature: Te (100°) . 0i(.986) 98.6°F. But when Te drops to 20°F, the 0i increases to 4.93 adaptation factor: Te (200).Oi (4.93) 98.6°F. The purpose of including the foregoing crude equation is to make the point that the body is not merely a static entity acled upon by external conditions. Each individual possesses an intrinsic, biological dynamic that interacts with and greatly modifies the external forces with which it comes in contact. This ever-present interaction of in­ ternal and external forces is evident not only in temperature maintenance, but in such other examples as the digestion of food (body chemistry adaptively interacting with foodstuffs from the en­ vironment) , the circulation of blood (blood pressure and heart rate adaptively interacting with the forces of gravity and atmospheric pressure) , and resistance to disease (neutrophils adaptively interact­ ing with an immune complex) . We can say that an individual's state of the organism is the prod­ uct of the interrelationship of the total internal dynamic and the total external dynamic. The product of this state of the organism equa­ tion determines the position that an individual occupies at any given =

=

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The Nature of Health and Disease time in the biological spectrum. It must be remembered that since the internal and external factors of the equation are constantly and sometimes drastically changing, they do not always produce the desired resultant (Le., Te . Di 105° F!). The state of the organism equation stresses the fact that an organism does not experience a change in the resultant (e.g., malabsorption of food) unless change has occurred in one or more, or all, of the internal and external factors of the equation. It should also be noted that hundreds of external and internal factors may undergo change while the overall condition of the organism remains constant. The concept of the state of the organism being the result of an equation is helpful in illuminating the philosophical and practical differences between allopathic and chiropractic physicians. Chiropractic em­ phasizes the fact that when the patient's state of the organism �ndergoes a departure from the Ideally well state, it is most Iike!y due to an aberration in the internal dynamic - not an external fac­ �. This we know from the statistical fact that wellness is much more common than illness, despite the fact that we live in a continually changing, ever-threatening environment (toxins, traumas, microrganisms, temperature extremes, poor diet, stress, etc.). Because the human organism is blessed with such a powerful homeostatic mechanism, chiropractic focuses its attention on those factors - in­ sults to the neural system and disregard for the common rules of health - which most readily undermine the body's resistance. The goal is to restore resistance before a serious disease can develo . And primary to the body's interna stabilitv is its ability to instantly and acclITately sense itseI=lViF9nmQI=lt Equally important is the body's ability to react to this information in an unfettered, uninterrupted fashion. For these reasons, the vertebral subluxation with its crucial relationship to the> spinal cord and the spinal nerve roots is of utmost concern to the chiropractor. On the whole, allopaths do not deny the importance of such con­ cepts as homeostasis and preventive care. But judging from the way Western medicine has applied its knowledge and technology, it is evident that the predominant focus has been on the external factor in the state of the organism equation. As an article in Preventive Medicine noted, modern medicine "...knows virtually nothing of those positive factors responsible for wellness in individuals and societies." =

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