article archive
April 2006
Can you handle the truth?
by Dr. Matthew McCoy, vice-president, Research & Clinical
Science
"The truth. Malice may attack it, ignorance may deride
it. But in the end there it is." ‑‑ Winston
Churchill
In the movie "A Few Good Men," Tom Cruise presses
Jack Nicholson to tell him the truth throughout the movie
and in the final climactic scene Nicholson barks back: "You
can't handle the truth" and proceeds to lay out all
the truth Cruise was seeking and then some. Cruise is visibly
shaken for a brief period as he begins to hear and digest
the raw reality presented to him.
We face a similar situation
within the chiropractic profession at the current time and
I predict we're going to see more of it in the coming months
and years as the profession attempts to clarify how it feels
and where it stands on certain issues.
All too often, chiropractic
is criticized as an "unscientific" discipline,
lacking empirical research to validate the assertion that
vertebral subluxations have an adverse affect on the human
nervous system, on general health and well‑being and
by extension, society as a whole. Unfortunately, this criticism
is not taken seriously by the leadership of the profession ‑‑ especially
the faction of the profession that should be on ultra high
alert regarding this issue ‑ the subluxation based
portion of the profession. A leader in the profession recently
wrote the following regarding how to eradicate the widespread
opposition to chiropractic:
"...the chiropractic wellness
lifestyle will prove itself, especially if we get the right
people to pay attention."
In over 100 years, the chiropractic wellness lifestyle has
not proven itself other than to the less than 7% of the population
using it. Making matters worse is that the percentage of
the population that are seeking chiropractic services is
decreasing ‑‑ not increasing. This is occurring
at the same time that enrollment in chiropractic colleges
is down 40% and while other professions are encroaching on
our turf.
Chiropractic is not going to prove itself. A concerted
effort must be made to demonstrate the health benefits that
chiropractic imparts to individuals and to society as a whole.
And that effort must be research‑based. Once the research supports
our contentions then we can get "the right people to
pay attention." Anything else is a fairy tale.
So just
who is actually doing something to provide the needed evidence
we are in such desperate need of?
Research and Clinical Science
(RCS) for one.
RCS has set out on the systematic study of the
epidemiology and global burden of vertebral subluxation. This
study is being carried out by individuals and groups with a
worldview towards chiropractic that is consistent with the
theory that subluxations pose a hindrance to the fullest expression
of life. The results of this type of research can then be used
to drive policy, not only in health care, but in education
and other sociocultural arenas.
RCS has developed a model of
training and linking chiropractic practitioners, researchers
and teaching institutions through a centralized network and
a web‑based, electronic data
repository in order to provide comprehensive, consistent
and comparable information supporting such a worldview on
the global burden of vertebral subluxation. This is not another
low back pain study!
During this process of clarifying conflicts
it is wise to remember that there is truth and there is that
which is not the truth. While it is sometimes seems less painful
to bury your head in the sand and ignore the reality of the
situation the truth is ‑‑ ignorance is not bliss. I'd like
to define some of the "truths" facing us as a profession
right now.
Truth #1: The ACC Paradigm
While this was and still is billed
as the great uniting document for the profession it does not
appear that everyone is living up to their part of the bargain.
Much has been written about the significance of all our College
Presidents getting together and agreeing on some basic fundamental
issues and the subsequent endorsement of it by all national
and international organizations. It is, in fact, agreement
on the ACC Paradigm that is a mandatory requirement for participation
in the National Chiropractic Leadership Forum (NCLF).
The bottom
line with the ACC Paradigm is the spectrum portion of the document.
At one end you have the straightest of straights and at the
other you've got a DC who is just a scope of practice change
away from being an MD. The beauty of the document lies in the
implied and often stated declaration that everyone at the extremes
and everyone in‑ between is "safe." The
straights are safe because the document allows for a strict
subluxation only practice and the mixers are safe because
the document allows for the implementation of broad diagnostic
and treatment procedures.
At the NCLF meetings the World Chiropractic
Alliance was clear that it could live with and endorse the
document because of the "live and let live" message.
Unfortunately everything is not always what it seems. In truth,
the portion of the spectrum that repeatedly gets attacked by
state boards, malpractice and the broader scope devotees are
those chiropractors that choose to limit their practice to
the analysis and correction of subluxation. This happens even
in situations where the chiropractor has consent and understanding
from the patient that this is their sole practice objective.
The
truth is that rarely will you see a state board attempt to
sanction the license of a broader scope practitioner. The further
truth is that rarely will you see a state Board attempt to
revoke the license of a practitioner using gross, non‑specific manipulative procedures to treat pain
syndromes, but you will see subluxation‑based chiropractors
who use evidence based procedures being called before them
and accused of practicing unscientific and unproven methods.
I've
been involved in expert witness work for some time and keep
thinking that I have seen just about everything. But I get
proven wrong on a daily basis. The "experts" for
the prosecution typically portray subluxation‑based
chiropractors as inept, uneducated, unscientific public health
menaces. Typically they are painted as snake oil salesmen
only interested in seeing how many visits they can get out
of a patient. These opinions are always supported by experts
who are members of "bigger" and more "scientific" organizations,
as they like to pretend.
The truth is that when the light is
shone on them, they lack the evidence and they are the menaces.
One recent attack on a subluxation based chiropractor involved
using "experts" who
not only maintained that there was no identifiable health
benefit from subluxation reduction in children, but that
subluxations in fact do not exist.
Imagine explaining to a judge
and jury the intricacies of immobilization degeneration,
Wolf and Davis' Law, neuroplasticity and the finer points
of connective tissue rheology. Another involved a chiropractor
using Network technique and the allegation that it was not "scientific." When it was shown
that Network has more science behind it than the diversified
technique promulgated by the Board members it was another
example of "you can't handle the truth."
These are not isolated cases. They are happening everyday
to chiropractors throughout the world and the actions are
fueled by those within the profession that cannot "live
and let live." This is why clinical outcomes research
is so crucial.
Truth #2: Rodney King syndrome
We're hearing the pleas of "can't we all just get along" from
many leaders in the profession these days and I suspect that
it will increase. There are even those leaders who refuse
to talk or work with other organizations unless and until
they succumb to their will, see things their way and merge.
I avoided those guys like the plague in the sand box and
schoolyard and I avoid them now as adults.
That's not to say
I don't understand the yearning to be "one" and
have unity. I've gone through all the bleary eyed possibilities
should this happen. But perhaps our divisions are not as
bad as we make them seem to be. Perhaps chiropractic's divisions
are actually evidence of professional vigor. After all what
is the alternative? That our divisions are the result of
some arcane misunderstanding? I doubt it and the more I talk
to students, practitioners, and especially practitioners
defending themselves for their lives, the more I am convinced
that real differences divide chiropractors and that our history
is dignified by our serious quarrels. The profession is not
split because you can't split rotten wood.
Truth #3: The profession
has spoken
The notion by some that this or that organization
or group represents the profession or even a substantial segment
of the profession is the height of denial. On a good day only
about 10,000 chiropractors belong to any national association
so the vast majority of chiropractors have already voted ‑‑ with
their feet and their apathy.
The profession has also spoken
in the recent study titled: "How
Chiropractors Think and Practice." According to this
study we're all pretty much doing the same thing: adjusting
our patients for subluxations, providing wellness care and
teaching lifestyle modification to assist in the healing
process. The study pretty nearly mirrors the ACC Paradigm.
But again the truth is that in practice we have the self
appointed experts who say subluxations have not been proven
to exist, that a practice based on wellness is not evidence
based and that you must practice to the absolute limit of
your licensed scope.
Truth #4: Solutions and problems
The profession is currently
facing some serious problems. RCS offers a number of solutions
and remains committed to working with those groups and individuals
that wish to work towards common goals aimed at overcoming
these problems. We believe the solution is in the evidence
and we have developed an ambitious research project to gather
that evidence.
The longitudinal time‑series population‑based
clinical outcomes study established by RCS is a systematic
and ongoing analysis of the clinical indicators (outcome
measures) that characterize vertebral subluxation. This process
is designed:
1. To evaluate and document outcomes information,
the health benefits, risks, utilization, and efficacy of approved
and existing chiropractic procedures.
2. To provide a measure
of continuous quality assurance and improvement.
3. To evaluate
long‑term benefits and risks of chiropractic
care.
4. To provide scientific evidence for efficacy in large
populations of patients under chiropractic care.
5. To allow
comparison of the risks and benefits of several available techniques
used to manage the same condition.
6. To identify disparities
in health status and use of chiropractic health care by race/ethnicity,
socio‑economic status,
region, and other population characteristics.
7. To monitor
trends in chiropractic health care delivery.
8. To support health
research.
9. To provide information for making changes in public
policies and programs related to chiropractic.
10. To evaluate
the impact of health policies and programs related to chiropractic.
RCS
can not accomplish this alone ‑‑ it needs
practitioners just like you out there in the trenches, caring
for patients and collecting the clinical data so vital to
advancing the agenda of subluxation based chiropractic.
Truth
#5: The Principle is not ours
I encourage you to think of the
fullness of time when considering decisions being made today
about the direction and focus of research in the profession.
What will the profession look like 10, 20 or 50 years from
now? As difficult as it might be for some to hear, the principles
the profession is based on really do not belong to us. They
belong to humanity and those groups and individuals that demonstrate
the best stewardship of those principles will be given the
honor of providing those benefits to humanity.
Will it be the
chiropractic profession that is releasing the imprisoned impulse
50 or 100 years from now or will it be some other provider?
I believe the answer lies in a group of dedicated individuals
that have a strategy based on what is best for humanity and
who are guarding the honor of carrying that benefit to them.
(Matthew
McCoy, D.C., vice‑president of RCS, is Editor
of the Journal of Vertebral Subluxation Research and Director
of Research at Life University College of Chiropractic. He
is a founding board member of the Council on Chiropractic
Practice currently serving as its Vice President and Chairman
of the Guidelines Committee and Vice Chair of the Research
Committee. He is the Representative of the CCP for the National
Chiropractic Leadership Forum and is the WCA liaison to the
Institute of Medicine's Committee on Complimentary and Alternative
Medicine. As chair of the World Chiropractic Alliance's Chiropractic
Advocacy council he assists doctors in defending themselves
in malpractice actions and board complaints. He has served
as an expert witness and consultant in numerous state board
actions, malpractice cases, peer review, insurance and IME
issues. He can be reached at info@rcsprogram.com)