article archive
November 2006
What research papers do you
use in your practice?
by Dr. Matthew McCoy
A recent California newspaper article quotes
a doctor of chiropractic as saying, "It is becoming
more important to provide some kind of scientific evidence
for what you do."
When wasn't it important? Granted, for a long time, "scientific
evidence" might be little more than the practitioner's
own clinical experience coupled with anecdotal evidence from
patients. Still, the importance of scientific evidence was
understood as far back as the Roman Empire. By the middle
of the third century BC, doctors in Alexandria, Egypt, were
beginning to conduct systematic dissections of animals and
human bodies, and even vivisection, notes Ann Ellis Hanson,
PhD, senior research scholar and senior lecturer in Classics
at Yale University.
An interesting article on the history of
medical research in the Action Medical Research Journal pointed
out that, "A
surgeon to the gladiators, Galen, though Greek by birth,
was to become the most influential of (the) Roman doctors
in the 2nd Century AD. As the first researcher to make a
detailed study of muscles, veins, arteries, nerves and the
heart, Galen won universal acclaim, and his teaching was
accepted for centuries afterwards."
In chiropractic, too,
the importance of research has been understood since the earliest
days of the profession. DD Palmer himself conducted years of
years of independent research and study of human health and
disease. BJ Palmer continued that research, as have numerous
others during chiropractic's first 100 years of existence.
Why,
then, do our critics continue to insist we have no evidence
to support what we do as chiropractors?
Part of the problem
rests with the evolving definition of scientific evidence.
A court of law may accept one type of evidence as "proof," while the scientific community
scoffs at it. There are numerous books, journal papers and
discussions on what constitutes acceptable evidence. One
long‑held benchmark (first codified in a 1923 court
case) was that scientific evidence "must be sufficiently
established to have gained general acceptance in the particular
field in which it belongs."
Although that decision was later overturned, many people
still considered evidence to be "acceptable" only
if it was generally accepted in the profession it applied
to. Therefore, "medical" research (and chiropractic
was lumped into the category) had to receive the imprimatur
of the medical profession in order to be considered valid.
Naturally,
chiropractic was ‑‑ and still is ‑‑ hard
pressed to come up with any research findings that would
satisfy and be accepted by the medical profession. Therefore,
much of the last century's research has been shrugged off
as irrelevant or questionable.
More recent research, conducted
by reputable colleges and published in respected scientific
journals, isn't as easy to dismiss. Still, our critics try
to disparage chiropractic research by categorizing chiropractic
journals as somehow inferior to medical journals, even if
they use the same peer review procedures. Not only do we
have to follow medical protocols, we have to be published
in medical journals ‑‑ a
difficult task considering the papers must be judged by medical
editors and researchers who continue to exhibit a definite
bias against chiropractors (often because, in the inevitable
Catch‑22 situation, they lack scientific evidence!).
Still,
despite all the hurdles put in our way, the chiropractic profession
has accumulated a promising store of scientific evidence exploring
everything from the impact of subluxation on wellness to the
affect of chiropractic on headaches. The evidence is there,
yet most DCs seem unaware of it.
Ask the average DC to cite
a research paper about chiropractic and you'll often hear about
the Manga study, which found that "spinal manipulation" applied by chiropractors
was more effective than alternative treatments for low back
pain in adults. That's fine, but the report was issued in
1993 and its conclusions were later refuted by Dr. Paul Shekelle,
who noted that Manga had looked at "the exact same studies
as the rest of us, and no one else has been able to come
to those conclusions."
Shekelle conducted the equally famous RAND Study, which
DCs like to point to as compelling evidence for the effectiveness
of chiropractic. Yet, the study really said only that manipulation
was useful for acute low‑back pain in patients showing
no sign of lower‑limb nerve root involvement. The researchers
recommended trying two different types of manipulation for
two weeks each, and then discontinuing therapy if there was
no improvement.
Shekelle later wrote an article to clarify the
findings, stating, "RAND's studies were about spinal
manipulation, not chiropractic, and dealt with appropriateness,
which is a measure of net benefit and harms. Comparative
efficacy of chiropractic and other treatments was not explicitly
dealt with."
Few doctors can discuss more recent scientific
findings, such as studies indicating that chiropractic may
have a beneficial impact on basic physiological processes affecting
oxidative stress and DNA repair.
Or what about the study of
81 cases that revealed the possibility that the correction
of upper neck injuries might reverse the progression of both
Multiple Sclerosis and Parkinson's disease?
What of the recent
case study of an eight‑year‑old
child with learning and behavioral disorders often associated
with ADHD who received weekly chiropractic adjustments consisting
of SOT pelvic blocking procedures and cervical adjustments?
After two months, the child experienced a reduction in pain
and discomfort which allowed him the ability to concentrate,
learn and "sit still."
Or the study of 14 autistic
children in which two of the children receiving upper cervical
adjustment protocol no longer met the criteria to be considered
autistic following the interventions?
I can list dozens of other
studies published in the last few years that every doctor of
chiropractic should know about. But few do. Instead, they are
totally unprepared when asked about scientific research.
There
are actually two distinct problems, then: 1) not having enough
of the right kind of research to support chiropractic as a
scientific, evidence‑based approach to wellness;
and 2) failing to be familiar with and use the evidence we
do have.
The first problem is a long‑term effort that is being
addressed by individual researchers, our colleges, and RCS
(Research & Clinical Science).
The second problem is one
you can take care of now by subscribing to the Journal of Vertebral
Subluxation Research (jvsr.com) and other research journals,
keeping up to date with current research, particularly on the
vertebral subluxation complex. You should have printed copies
of the abstract in your office and include stories about them
in your office newsletter. Have a file folder filled with reprints
of important research papers, ready to refer to when educating
patients, speaking with the media, or answering questions in
courts of law or before their boards.
Like so many other valuable
tools available to you as a chiropractor, research won't do
you any good if you don't use it.
(Dr. Matthew McCoy is one
of the founding members of the Council on Chiropractic Practice
and has been instrumental in the development of the profession's
most widely accepted set of chiropractic guidelines. He's also
editor of the Journal of Vertebral Subluxation Research and
has extensive practice, research and educational experience.
He gained international acclaim when he helped introduce chiropractic
to the Russian medical community by developing a chiropractic
spine treatment, teaching & research center in Vladivostok, Russia. He
is currently the Director of Research at Life University.
Dr. McCoy is Vice‑President of RCS, serves as a member
of the WCA Board of Directors, chairs the WCA Chiropractic
Advocacy Council and was a liaison member of the National
Academy of Sciences and Institute of Medicine's Committee
on Alternative Medicine. He can be contacted via e‑mail
at editor@jvsr.com)