Is chiropractic ready for research?

Dr. Phillips Reed B., DC, PhD^*

Is Chiropractic ready for research? This is a most interesting question that can be approached on multiple fronts.

1. Academically – What do we mean by the terms “chiropractic” or “research?” What do we mean when we say “ready?”

2. Scientifically – Are we talking about the entire profession or a subset? Do we make an assumption that our external validity will make our data generalizable to the universe of potential chiropractic respondents?

3. Historically – Were we ready for research when B.J. introduced the neurocalometer? Were we ready when Janse and Illi published their seminal work on the Spine: The Lifeline of the Body? Were we ready when NIH hosted a conference on the Status of Spinal Manipulative Therapy? Were we ready when Scott Haldeman started to organize profession wide scientific conferences?

4. Economically – What have you felt when the Canadians were being subjected to the turmoil of the Inquest on Strokes caused by Manipulation? Did your feelings change when the Neck Pain Task Force published their findings? Did any of this impact your practice?

5. Socially – Surveys have demonstrated a growing use of “alternative therapies” over the last two decades. CAM continues to grow in acceptance and recognition. Chiropractic doesn’t seem to be reaping the benefits of this in North America. Why?

The answer to the question is, “It really doesn’t matter if chiropractic is ‘ready’ for research or not, it is going to happen regardless.”

The research enterprise is deeply ingrained in our culture today. Through it we find solutions to problems, improve our health and our quality of life, expand our understanding of the world we live in and learn more about what makes us tick. There is no single entity or force that can either turn research on or turn research off. Granted, federal agencies, private and corporate foundations provide funding for the process but the majority of it is driven by potential for personal and financial gain as well as for benevolent purposes. The wheels are in motion and they cannot be stopped.

Chiropractic usually considers itself ‘behind’ in the research enterprise. When we compare the research work conducted in our educational institutions with the work done at most major research universities, there is a definite disparity. The numbers of qualified research personnel and the amount of funding from outside the profession to support our work is a mere pittance compared with major research universities. Some of our chiropractic educational institutions gallantly pursue the research enterprise with modest success while others never advance beyond the pilot study level.

Beginning in the mid 1970’s, the chiropractic profession made a dedicated effort to support the training of able and ambitious individuals from within the profession. The Foundation for Chiropractic Education and Research (FCER) initiated its Fellowship support program and has continued this support for numerous individuals up to the present day. What started as a modicum of support for Scott Haldeman and me, has now blossomed into support that has lead to the awarding of Master’s and Ph.D. degrees to more than one hundred doctors of chiropractic –obviously a few less than the number found in any single major university department but none-the-less a critical mass to advance the chiropractic research agenda.

The disappointing side of this remarkable transition is that many of these well-qualified, research-trained DC’s are doing their research outside of the chiropractic profession for there is no place within the profession to support their level of specialty training.

In spite of the profession’s effort to address the research enterprise, in what appears to be a less than desirable effort, chiropractic remains undaunted in its conviction to be a meaningful part of the health care delivery system around the world. Some believe if the profession had more support, chiropractic’s role would be more prominent, permanent and pleasant in health care delivery. That may prove true, but typically research is not designed to “prove” one’s place in the sun – rather, research is designed to eliminate falsehoods, rumors, failing theories and hucksterism.

The published scientific literature both from within and outside of the profession has validated chiropractic’s place in the sun, albeit a rather limited place mostly associated with the conservative management of acute low back pain. Nonetheless, a beachhead has been established. The profession’s investment of time, talent and treasures has netted favorable returns, but a war cannot be won from a beachhead alone. It is now time to press forward and gather into our paradigm that which the research enterprise can rightfully justify.

Our enemies will attack chiropractic with the very weapons we rely on to protect ourselves and to advance the cause of our patients ... evidence. Evidence derived from the research enterprise along with evidence derived from clinical experience and rational thinking. We function in an evidence-based health care milieu. We cannot escape it and we cannot ignore it. But we must never forget the adage, “The absence of evidence does not equate to the evidence of the absence of support.”

Chiropractic faces challenges never imagined forty years ago. When I started my chiropractic training in the early 1970s I recall reading government reports, attorney general opinions and scientific articles all echoing in concert the fallacy of chiropractic theory and chiropractic methods of treatment. With the research that has been accomplished over the last forty years, the cacophony of voices still challenge the theoretical basis of chiropractic’s philosophical roots, but our method’s of treatment have been adopted by every form of hands-on practitioner known to man. And therein lays our greatest challenge.

Research has created a solid foundation for spinal manipulative therapy as a valid treatment for a limited number of conditions. Most of this research has been done outside of the chiropractic profession. As a result, a race has begun. Who will “own” the right to be the preferred provider of SMT? Who will gain the cultural authority that will allow society and the learned professions to say with clarity – “Provider ‘X’ or profession ‘Y’ has demonstrated through the research enterprise and its associated educational programs the right, the privilege, the prerogative to be the preferred provider of spinal manipulation?”

Can chiropractic compete in this race? Can chiropractic compete with physical therapy, massage therapy, physiatry, or osteopathy? – because we cannot remain competitive on the strength of our philosophical roots alone; nor can we compete from the position of entrepreneurial business schemes, gimmicks, and other forms of what often borders on “hucksterism.” Politically, the profession remains an entity to be reckoned with but our voice of reason could be stronger and our nemesis of falsehoods could be negated if supported with more scientific documentation.

Thus, whether the chiropractic profession is ready or not for research really doesn’t matter. The research enterprise is taking off, and we will either get on the train or be left standing at the station. We get on the train by getting involved, by investing in the enterprise, by supporting our educational institutions and FCER and by reading what is being produced by the enterprise already in place.

We are all busy and most of us are unfamiliar with the research terrain. There is a crying need to help the doctor in practice get a handle on what is available in the way of research evidence as it relates to what is happening in his or her practice. FCER has launched a web site, DCConsult^sm, as a vehicle to provide access and understanding of the research literature. More information can be found at www.fcer.org.

I have been around long enough to realize that the chiropractic profession has advanced remarkably and will continue to do so from those early days when I first qualified for a small research grant with FCER. This same foundation can now provide immediate critical information for the doctor in practice, the chiropractic educator, the chiropractic politician and the chiropractic research enterprise. Let’s all get on board.