January 2003
See
also: Chiropractic Research Infrastructure
and What Can be Done?
The role of science in chiropractic: A time
for change
by Matthew McCoy, D.C., Editor, Journal of
Vertebral Subluxation Research
Reprinted from the Journal of Vertebral Subluxation Research, with
permission.
The National Science Foundation recently released their
biennial report on the state of science understanding, education, research
and investment. The report titled "Science and Engineering Indicators
2002" included a survey of American's attitudes about science.1
The Survey found that 70 percent of adults in the
United States
do not understand the
scientific process, that belief in "pseudo-science" is common
and that science literacy had improved only slightly since the last
survey. It would be interesting to see how the chiropractic profession
compares to the general population of Americans in this regard.
Science in the chiropractic profession
The Association of Chiropractic Colleges lists Science as one
of the three central pillars of the foundation of chiropractic in their
Paradigm Statement along with Philosophy and Art. The arrangement of the
Paradigm depicts the Purpose, Principles and Practice of chiropractic as
emanating from these three pillars.2-3
But the stark reality of the scientific infrastructure of our
profession should send a shudder through everyone's spine. The entire
chiropractic profession has less than 100 full time researchers with the
last count being approximately 70. Contrast this with the drug company
Pfizer which has 12,000 full time researchers. That's one drug company and
we have 70 for an entire profession. Money is obviously a big part of this
problem. For example, the total budgeting for all chiropractic
institutions is a mere $224 million. Contrast this with
Harvard
University
where they receive $739
million a year from the NIH alone and we get a clearer perspective.
Of that $224 million our institutions spend only $4 million
on research programs and less than 5% of full time DC faculty at
chiropractic institutions are involved in research of any sort. In the
entire 100 year history of the chiropractic profession we have probably
received less than $10 million from the federal government for research.
Again, contrast that with the top 25 medical schools and the fact that
they received $6 billion from the NIH in 2000 alone. All of this coupled
with the fact that less than 10% of our profession subscribes to a peer
reviewed chiropractic research journal leaves little doubt that we do not
place a high priority on science and research. 3-5
There's no finger pointing allowed here. Even if some faction
of the profession wanted to maintain that they are more scientific than
some other faction, the above listed facts still apply. This is our
collective problem as a profession and the answer lies in collective
responsibility and in a collective response. We maintain to our patients
that we are "doctors of cause" and the same applies to our
profession.
We must come to grips with reality about the nature of this
very deep, insidious and serious problem and explore the root causes while
at the same time developing a strategy to get out of the hole we're in.
Financial issues
Our chiropractic institutions are tuition dependent meaning
whatever money the schools have available for keeping their lights on
depends solely on how many students they have. All of our institutions
could learn a lesson from Palmer College of Chiropractic where they have
received $4.7 million in federal building grants since October 2000.6 This
money is being used to establish an infrastructure for chiropractic
research. In order for chiropractic institutions to become less tuition
dependent they must hire consultants to train their faculty in grant
writing and submission while educating everyone involved about the
procedures required to get money from outside sources. All faculty should
be involved in this process. I have a family member who works in the
public health field and her job, as well as everyone's on her staff, is
dependent on their ability to acquire grant money on a regular basis.
Medical schools receive over $2.2 billion a year directly
from Medicare to train their residents and they receive another $4.1
billion in indirect payments each year.7 For example Beth Israel Medical
Center receives an average Medicare payment of $57,010.00 a year for each
resident it trains.8 Chiropractic institutions receive zero dollars from
Medicare to train our residents. Why is that and can we change it?
A few good people
Chiropractic institutions must attract the best and brightest
the profession has to offer and must provide appropriate remuneration to
these individuals. For 100 years our chiropractic institutions have turned
out one product: practitioners. This must change immediately. Chiropractic
institutions must develop "Research Tracks" and incorporate them
into the curriculum as there is currently no outlet there for a student
who wants to pursue a career in chiropractic science and research. In fact
this is frowned upon and discouraged at many institutions by some faculty
and some leaders in the profession. We must develop a cadre of
practitioner/scientists and have a research industry in place to employ
them.
In order to do this, faculty at chiropractic institutions
must be trained in and encouraged to conduct and publish research. Many
agree that students must be required to participate in research during
their educational career but if the faculty are not doing it then this
does not set the example and is a blatant contradiction. For a start,
faculty must learn to use the peer reviewed literature in their courses
and students must be taught the skills necessary for critical thought.
The problems are so basic as to include the need to train
faculty in such topics as what peer reviewed literature is, how to find it
and how to incorporate it into a lecture. Students must demand more
detailed explanations of chiropractic science from their instructors and
the instructors need to encourage this type of discourse.
Responsibility of subluxation-based chiropractors
In May of 2000, a group of chiropractic educators and
researchers met and discussed the role of the neurosciences in
chiropractic education.9 According to their report: "There was a
consensus that a clear strand of neuroscience, integrating basic science
and clinical education, does not exist at any of the schools represented
at the meeting." How could it be that the fundamental anatomical and
physiological basis for the theory behind subluxation is not taught in an
integrated fashion at our schools? Integration of all of the basic and
clinical chiropractic sciences needs to become a priority at our
institutions and the oft repeated remarks by some instructors and leaders
that what students are learning in the basic sciences has nothing to do
with "real" chiropractic must not be tolerated.
This is especially true for subluxation-based chiropractic.
If an instructor does not see or accept the importance of understanding
the physiological and anatomical relationships to subluxation models and
subluxation epidemiology it must become clear that this instructor is
harming the entire profession. If an institution or an instructor does not
feel the basic sciences are taught in an integrated fashion or in
sufficient depth as to show this relevance then they should add the
appropriate depth and content to their course to remedy that. And at the
same time curriculum committees should examine their course offerings and
make changes that support such integration and exposure.
Subluxation-based chiropractors especially need to develop an
absolute no tolerance policy for instructors and leaders who espouse
rhetoric that science is not essential to the development of subluxation-based
chiropractic. We must immediately sever any connection with these
radicals. Similarly we cannot embrace scientism and must remember that the
ACC Paradigm places Philosophy as the main brick upon which the Science
and Art are placed. Those who are leery to take a watchful eye off the
position of philosophy in our profession need to work to strengthen that
philosophy by engaging in scholarly activity in this area instead of
perpetuating quasi-religious dogma. The philosophy of our profession is
not and should not be stagnant. Just as we need chiropractic scientists,
so too we need chiropractic philosophers who are experts and scholars in
this area. Reading all the Green Books does not a chiropractic philosopher
make.
Subluxation-based groups, schools and individuals must engage
themselves heavily in the research process. This can be done through
strategic partnerships between these parties where priorities can be
established and a plan can be devised. We need the chiropractic equivalent
of a Bell Lab and the Manhattan Project.
There are more than 16 institutionally affiliated
chiropractic outpatient clinics that see thousands of patient visits each
year. Are the outcomes of this care being tracked, recorded, analyzed and
published? We have the chiropractic equivalent of a Framingham Study in
our own backyard and we are not taking advantage of it. Imagine if each
school could agree to meet and come up with a plan to track the outcomes
of the care rendered in all of our school's clinics. We're all adjusting
patients in these clinics, we all need to monitor those patients, and we
could all agree on parameters to measure physical and quality of life
changes. What is stopping us?
Subluxation has an epidemiology and since we say we are the
sole profession who has the right to address subluxation, then we have the
responsibility to engage in research that will elucidate an understanding
of that epidemiology. Can you imagine if oncologists as a group did not
seek to understand the epidemiology and nature of cancer? They would have
no business treating patients or giving advice on how to deal with it. Ask
a recent graduate of a chiropractic college to extemporaneously discuss
the nature and epidemiology of vertebral subluxation and you might be met
either with a distant stare or with a layperson's version of "above
down inside out." Worse still they might purport that subluxations do
not exist.
The role of the practitioner
Continuing with the theme that this is a profession wide
problem needing a profession wide solution, practitioners must engage
themselves in the process. Too many graduate from chiropractic college,
step into practice and leave behind any memory of scholarly activity. The
thought of sitting through a real post graduate seminar when they could be
sitting on the beach or skiing is a real problem for some practitioners.
Conventions that condone and encourage signing in and out without actually
attending the program reinforce this behavior.
Each member of this profession needs to commit to
participating in several research oriented activities every year. This
could be simply subscribing to a peer reviewed chiropractic journal,
donating money to a chiropractic research association and attending a
scientific symposium. Those practitioners who have been fortunate enough
to amass a small fortune must step forward and put some of that money to
use in chiropractic research. Build a building and put your name on it if
that's what it takes.
Every practitioner must commit to taking an interesting case
from their office and compiling a case study and submitting it to a peer
reviewed chiropractic journal. The next time you hear a chiropractor brag
about all the people he's gotten out of wheelchairs ask him why he has not
written them up, subjected them to peer-review and attempted publication.
Others who are more inclined need to engage in more advanced forms of
practice based research. This information could be compared to that
gathered by the institutions and important information might be gleaned
from it.
Hear the hoofbeats?
A colleague of mine recently remarked about his frustration
with all the infighting in our profession. He said our profession was
fighting and arguing amongst ourselves over a crumb in the corner while
somebody walked off with the pie. When we finish with the crumb we'll look
up and be in for quite a shock. If you are not aware of it yet, somebody
has walked off with the pie, actually several have. Osteopaths are
duplicating our principles and practices and the physical therapists are
on their way to becoming primary health care providers and maintain that
they too correct subluxations.10
If the federal judge presently sitting on the decision in the
HCFA suit does not rule in our favor then MD's and DO's will have the
legal right to correct subluxation. We're no longer talking about
something that will happen someday in the hazy, distant future. Much of it
has already happened. Wellness and holistic care, mind-body healing,
spirituality, the use of touch in health care etc. are all being embraced,
studied, codified and practiced by other professions. And what exactly
have we been doing besides fighting amongst ourselves?
References
1. "Science and Engineering Indicators 2002."
National Science Board. National Science Foundation. April 2002.
Arlington
,
VA.
www.nsf.gov/sbe/srs/seind02/start.htm
2. "The Chiropractic Paradigm." Association of
Chiropractic Colleges. 1996 www.chirocolleges.org/paradigm_scopet.html
3. Phillips, R.B. "The Chiropractic Paradigm." The
Journal of Chiropractic Education. Vol. 15, No. 2, 2001.
4. Flanagan, J., Giordano, J. "The role of the
institution in developing the next generation chiropractor: Clinician and
Researcher." Journal of Manipulative and Physiological
Therapeutics. March/April 2002.
5. "
America
's Best Graduate Schools
2003: Top Medical Schools."
U.S.
News and World
Report.
www.usnews.com/usnews/edu/grad/rankings/med/brief/mdrrank_brief.php
6. "Second $1.7 million federal building grant to
Palmer." Dynamic Chiropractic. www.chiroweb.com/archives/20/04/11.html
7. Iglehart, J.K. "Support for Academic Medical Centers
-- Revisiting the 1997 Balanced Budget Act."
New England
Journal of Medicine.
July 22, 1999
. Vol. 341, No. 4.
www.nejm.org/content/1999/0341/0004/0299.asp
8. Pear, R. "Study Highlights Disparities in Aid to
Train Doctors." New York Times.
July 25, 1999
.
9. Bub, G.A. et al. "Neuroscience in the chiropractic
curriculum." JNMS. Vol. 9, No. 3. 2001.
10. "APTA Claims Right to 'Correct a Subluxation.'"
Dynamic Chiropractic www.chiroweb.com/archives/19/13/02.html
(Matthew McCoy, D.C., is presently Editor of the Journal
of Vertebral Subluxation Research and an instructor at
Life
University
College
of Chiropractic. He
has practiced in both the
United States
and
Russia
since graduating from
Life in 1989. Dr. McCoy has pursued extensive Post Graduate training and
maintains active involvement in several chiropractic political and
research organizations including: The Council on Chiropractic Practice,
World Chiropractic Alliance, The Chiropractic Advocacy Council,
International Chiropractor's Association, Council on Applied Chiropractic
Science, Council on Chiropractic Clinical Science, Georgia Council of
Chiropractic, Academy of Upper Cervical Chiropractic Organizations and The
International Spinal Health Institute. He is also a member of the Post
Graduate Faculty of
Life
University
College
of Chiropractic. A
sought‑after speaker and expert witness, he can be reached at
editor@jvsr.com).
