Table 1 A list of signs of incompatibility between the evidence-friendly and traditional factions in chiropractic, described as it would be in an unhappy marriage, as seen from the evidence-friendly view point

Love

• It is evident that there is no love between two groups. Neither wishes to spend time or more intimate moments with the other.

Respect

• There is little tolerance between the two factions.

Agreement on common basic concepts

• The evidence-friendly group adopt a natural sciences critical thinking approach and more easily accepts good quality scientific studies, regardless the results, while the others disregard evidence, if it does not confirm their prior beliefs. Traditional chiropractors are also prepared to accept substandard research such as case-reports as evidence.

Easy communication; togetherness; similar interests

• The two factions find it difficult to communicate because the evidence-friendly groups seek to use contemporary mainstream language, whilst the others stick to traditional language, e.g. ‘subluxation’, ‘innate intelligence’, ‘adjustment’, ‘the power that made the body heals the body’, and ‘treat the cause not the symptoms’.

• There is no problem-solving mechanism. Therefore, central collaborative problems will rarely be discussed in order not to rock the boat too much.

• Explanations to the patients about illness and health are different in the two camps; therefore it is difficult to exchange patients.

Extra-marital sex / infidelity

• The evidence-friendly chiropractors are seen as unfaithful by the traditionalists, as they ‘sleep’ with or have been seduced by members of external conventional health professions such as medicine and physiotherapy.

Intellectual differences

• The two groups do not attend the same type of seminars or conferences nor sit at the same table, when they are in the same room.

• The improved status of the chiropractic profession depends largely on their participation in producing new evidence and this is done by the evidence-friendly group.

• Very little of the research produced so far has succeeded in showing that treatment by chiropractors is superior to that delivered by other healthcare professions. Although the evidence-friendly group finds this disappointing, they maintain a patient-centered focus, confident that acceptance of truth is a necessary path to the best treatment options for patients as well as to mainstream acceptance of chiropractic methods. The traditional chiropractors seem unable to come to terms with this situation and build their professional activities and discourse on idealistic assumptions that either cannot be tested scientifically or are based on outdated health care models.

Disrespect, rudeness and nastiness

• Virulent attacks in social media are apparent when a scientific publication produced by evidence-friendly members fail to ‘prove’ what the traditionalists consider obvious, because they see proofs of this “every day in their clinics”.

Economic situation

• Evidence-friendly chiropractors are concerned about the traditional chiropractors’ exaggerated claims about cures, prevention and even longevity, which they consider deceptive. They think that biologically implausible claims and the resultant practice behaviours will have or have already affected the economic situation of the chiropractic family by creating distrust of the public and limiting the growth of the profession (i.e., the proportion of people seeking care).