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May 2006

Study says chiropractic 'doesn't work'
by Dr. David A. Jackson

As though the chiropractic profession needed any more bad news, a recent research study published in the Journal of the Royal Society of Medicine, concluded that there is little or no evidence that "that spinal manipulation is an effective intervention."

The research ‑‑ that involved analysis of 16 studies published between 2000 and 2004 ‑‑ was on spinal manipulative therapy performed by both osteopaths and chiropractors. However, most readers assumed the report was about chiropractic. The general public, after all, doesn't realize that many chiropractors don't do SMT but perform spinal adjustments to correct vertebral subluxations. This is definitely the downside of the decades‑old campaign by some elements in our profession to link chiropractic to "spinal manipulation" rather than create our own unique identity.

One online news outlet summarized the report with an article headlined "Spinal Manipulation May Be Useless ‑‑ or Worse," that stated "Having your back 'cracked' to ease pain and other problems is a waste of time and money ... and in some cases ... it can make the problem worse."

The same type of coverage appeared in newspapers around the globe (a quick Google search found articles in publications from California to Turkey).

Here are some of the other headlines:

"Spinal manipulation by chiropractors no better than sham manipulation." ‑‑ What is the Word, Maharashtra, India

"Spinal Manipulation Doesn't Work For Any Condition, New Research Finds" ‑‑ Medical News Today

"An expert has claimed that spinal manipulation can be dangerous" ‑‑ The Telegraph, UK

"Manipulation of the spine 'is of little use for treating any condition" ‑‑ The Scotsman

"Spinal manipulation 'has little effect on back pain'" ‑‑ The Independent, UK

"Chiropractors are offering 'worthless' form of treatment" ‑‑ Times of London

Many of these news reports failed to include comments from chiropractic or osteopathic spokespersons such as the British Chiropractic Association, which said: "(Researchers) Ernst and Canter have carefully selected negative articles in support of their conclusion that manipulation cannot be recommended as a treatment when national clinical practice guidelines, based on much more and better research than the studies this article has selected, has come to exactly the opposite conclusion. Professor Ernst has a track record of the disparagement of manipulation professions, especially chiropractic, which more capable scientific review has found to be groundless."

Few included this quote from Robert Lever, professor at the European School of Osteopathy: "Researchers are looking in the wrong place for evidence. If they spent a little time at a busy practice they would see the evidence."

Of course, I'm not surprised that Dr. Lever's statement didn't get more attention. After all, when people look for proof of a health claim, they don't look at actual practices, busy or otherwise. The real‑life experiences of patients who get well under chiropractic (or other types of care) are dismissed as mere "anecdotal evidence."

We can't counter this type of bad publicity by saying "come to my office and talk to my patients." That isn't going to "cut it" if we want to establish a 21st‑century image of chiropractic as a scientific, evidence‑based discipline. To generate worldwide headlines, we'll need to have solid, unimpeachable scientific evidence.

This means predicting the arguments ahead of time and making sure all the bases are covered.

First of all, the research we do must be on chiropractic not spinal manipulation. If we do research that proves the effectiveness of spinal manipulation, the osteopathic profession will be the prime beneficiary, not chiropractors. If the news is bad, chiropractors get the blame. If the news is good, osteopaths and medical doctors will get the credit. It's not fair; it's just the way things are. If the research proves the benefits of chiropractic adjustments to correct vertebral subluxations, we'll be ones to reap the rewards.

Secondly, the research must be based on a large enough sample of the population that no one can argue it's only a limited project. Yes, it's true that the medical and pharmaceutical industries often base their findings on a review of a handful of cases. For instance, a recent study that concluded some people should take drugs every day for the rest of their lives to prevent high blood pressure involved fewer than 800 people.

But if we come out with a report on 1,000, or even 10,000 people, the results will be attacked as inconclusive due to the small number of study participants. The RCS (Research & Clinical Science) program, for instance, aims at compiling standardized data on several hundred thousand volunteers (including people who have never received chiropractic care as well as those undergoing routine adjustments). With that number of subjects, no critic will be able to attack the research as "too limited."

They will, instead, try to attack its methodology. Fortunately, RCS has worked diligently to make sure the entire program was designed by expert researchers to comply with the most stringent protocol standards. It was carefully examined by an Independent Review Board (IRB) and fully approved, as were all the researchers and clinical investigators.

Critics won't be able to find fault with the RCS researchers, either, since the RCS International Scientific Advisory Panel is a multi‑disciplinary group made up of top researchers from around the world. Their papers have been published in numerous reputable scientific journals, including:

*** American Journal of Medical Genetics
*** American Journal of Physical Anthropology
*** American Psychologist
*** Archives of Internal Medicine
*** Archives of Physical Medicine and Rehabilitation
*** Brain Research
*** Cancer Journal
*** Clinical Neurology Research
*** International Journal of Integrative Medicine
*** International Journal of Neuropharmacology
*** Japanese Orthopaedic Surgeon Association Journal
*** Journal of Applied Physiology
*** Journal of Applied Social Psychology
*** Journal of Biochemistry
*** Journal of Biomedical Science
*** Journal of Cell Biology
*** Journal of Comp Neurology
*** Journal of Comparative Neurology
*** Journal of Human Evolution
*** Journal of Neurobiology
*** Journal of Neurochemistry
*** Journal of Neuroscience
*** Journal of Orthopaedic and Sports Physical Therapy
*** Journal of Psychiatric Research
*** Journal of the American Medical Association
*** Molecular Psychiatry
*** Nairobi Journal of Medicine
*** Neurochemistry International
*** New African Journal of Medicine
*** Operative Techniques in Orthopaedics
*** Proceedings of the National Academy of Sciences
*** Society for Neuroscience

I doubt if there are very many (if any) research programs taking place right now with such an impressive group of researchers.

Of course, the most rabid anti‑chiropractic critics might try to condemn the program merely because many of the volunteers choose to become paying patients after taking part in the research. But RCS has anticipated that possibility as well, and follows procedures similar to those used at the Mayo Clinic and other reputable research facilities.

For example, the Mayo Clinic issues FAQ sheets for its research projects and answers the question, "Will I need to pay for the tests and procedures?" as follows:

"You and/or your health plan will need to pay for all tests and procedures that are part of this study because they are needed for your regular medical care. The study drug will be given to you at no cost. However, you may need to pay for the preparing of the study drug. You or your health plan might also have to pay for other drugs or treatment which are given to help you control side effects. Before you take part in this study, you should call your health insurer to find out if the cost of these tests and/or procedures will be paid for by the plan. Some health insurers will not pay for these costs. You will have to pay for any costs not covered by your health insurer." (emphasis added)

Similar procedures govern research conducted by the University of Michigan Medical Center's General Clinical Research Center, one of 79 clinical research centers funded by the National Institutes of Health (NIH) at leading hospitals throughout the United States. Its informed consent form reads (in part):

"If the subject is receiving care for a condition or illness, and is seen in a protocol that involves an accepted form of treatment, either the patient, or the insurance company representing that patient, is responsible for the costs of that medical care. The NIH grant pays for only those tests and procedures performed for research purposes; room charges and standard treatment costs are charged to the participant's insurance." (emphasis added)

So, unless the critics are going to fault the Mayo Clinic and other medical research programs, they'll have to abandon this obviously absurd attack strategy.

Since the research program is completely legitimate and "air tight," the only thing left will be to print the headlines. They'll probably say things like: "Chiropractic found to strengthen immune system," "Study proves children healthier with subluxation correction care from birth," "Flu, colds, viruses zapped by chiropractic care, research finds," "Wellness levels improve with regular chiropractic care, study shows," etc.

With more doctors signing up to become RCS Clinical Investigators, we could be seeing news stories like that by the end of the year. All it takes is dedication to chiropractic research and a willingness to have a few dozen volunteers come into your office every month for a free examination and report of findings after they fill out an online Self‑Reported Quality of Life study. RCS even provides its Clinical Investigators with an exclusive "Vitality Wellness Report" for each volunteer, to show them how they "stack up" to others in the RCS health database. Those volunteers who wish to receive chiropractic care can do after signing the informed consent form, or if your practice is too busy to accept that many new patients, you can easily refer them to nearby colleagues.

Aren't you ready to read some good news about chiropractic for a change?

(Dr. David A. Jackson is chief executive officer of Research and Clinical Science ‑‑ RCS ‑‑ a private sector research program exploring issues of subluxation correction and chiropractic care as they relate to health and wellness. Previously, he served as president of the Chiropractic Leadership Alliance and Creating Wellness Alliance and was owner/operator of several private practice offices in California and Idaho that specialized in high‑volume, family wellness‑based care. For more information on RCS, call 800‑909‑1354 or 480‑303‑1694, or visit the RCS website at www.rcsprogram.com. Doctors of chiropractic may log on to a special limited‑access area of the site by using the username DC1 and password RESEARCH.)