July 2004

Chiropractic's only drawback

by Dr. Terry Rondberg

Did you get a chance to read the April 26th edition of Newsweek magazine? If not, you should search out a back issue (or go online at www.msnbc.msn.com/id/4767268/) and read the lead story on "Treating Back Pain." It provides valuable clues about the direction medicine is taking ‑‑ and the direction chiropractic must take in order to survive.

It's clear from the article that the medical establishment is beginning to adopt a chiropractic view of the importance of the spine in health. In many sections, the piece reads like a consumer's guide to chiropractic. The report explains that the spinal cord carries nerve signals between brain and body and that "shifted bones push against nerves, causing pain." Bones can shift because of physical and/or emotional stresses, the author, Claudia Kalb, notes.

Sound familiar?

The illustrations used in the article show the spinal bones impinging on nerves and are almost identical to those seen on posters in thousands of chiropractic offices. Although they're called "slipped vertebrae" rather than vertebral subluxations, the parallels are clear. The medical profession and the media are adopting our concepts and it won't be long before they begin using our nomenclature as well.

In fact, the article actually includes the word "adjustment" when referring to chiropractic care. When in pain, people want relief, Kalb explains, adding: "and a lot of them get it from the 'adjustments' chiropractors make to their backs." She even notes that "Some happy clients visit their chiropractors more than their barbers."

It's easy to underestimate the importance of this article or even dismiss it altogether as another back‑pain story. Yet, to the best of my knowledge, this is the first time in the 109 years of chiropractic history that a major mainstream publication has discussed the effect of vertebral subluxation on health.

Even if they didn't get to the point, yet, of calling it a subluxation, there's no doubt that's what they're talking about. Soon, we'll see an article that refers to a "slipped vertebra" but adds, "also called a subluxation." A subsequent report will probably drop the "slipped vertebra" entirely and quote an MD who calls it a "subluxation." The transformation from a chiropractic term and concept to a medical one will be complete, especially if our profession has discarded the word in favor of a more medical term.

But there's another ‑‑ possibly more important ‑‑ point made in the article.

A small sidebar on alternatives to surgery mentions chiropractic (this time using the more orthopedic term of "manipulation") and lists the pros and cons of non‑medical approaches. The pros are impressive: "cheaper and less risky than surgery. No recovery time, plenty of hands‑on TLC."

The cons? Just one. But it's a big one: "Dearth of good research to prove efficacy."

In other words, the only drawback to chiropractic as an alternative to surgery (at least when it comes to back pain) is a lack of research.

How many times have we heard that same criticism? How many times have patients decided not to try chiropractic because they've heard there's a lack of research and clinical science to prove its safety and effectiveness?

Some chiropractic research has been done already and we're constantly working to improve the quality and quantity of clinical science literature that will provide the basis for scientific, subluxation‑ and evidence‑based practices. That's why the World Chiropractic Alliance publishes the Journal of Vertebral Subluxation Research (JVSR) and works so hard to inform the health care community and the general public of its findings.

But when you hand your patients a pamphlet about chiropractic research, does it highlight the Magna report and the Rand study? Both of those are more than two decades old. Do you tell them about the New Zealand Commission Report ‑‑ dating from 1978‑80?

What about the Florida Workers' Compensation Study, the Washington HMO Study, or the Oregon Workers' Compensation Study? All focused on cost effectiveness and from the late 1980s and early '90s. That's ancient history when it comes to research and clinical science!

And almost all of these studies relate only to chiropractic and low‑back pain in adults. Where's the research that proves that chiropractic can strengthen the immune system, improve performance, and enhance quality of life? Where are the studies showing that it can help restore and maintain health in children as well as seniors?

We see the results of chiropractic every day in our offices. We know the damage vertebral subluxations can do, and how adjustments can have incredible results regardless of the age or condition of the patient. We also know that subluxation correction is the cornerstone of a wellness program. Chiropractic ‑‑ along with nutrition, exercise, stress management and other considerations ‑‑ is a key element in longevity and health.

We all know this, but now we have to create a "culture" of research in the profession and develop an overwhelming mountain of evidence in support of chiropractic.

We need to prove to scientists, using strict scientific methodology, that innate exists, that subluxations are real and that chiropractic adjustments to correct subluxations are a vital component of healthy living. Without the science to back us up, we have nothing but dogma and no alternative but to shop ourselves out as second‑class medical technicians trying to ride on medical coattails. Following this course, we'll wind up taking vitals and prepping patients for surgery for the "real doctors," who will act as gatekeepers and supervisors.

That's not what I want and I know it's not what most DCs want (except, perhaps, those who like to don white lab coats and wear stethoscopes around their necks). We don't need research to gain acceptance by the medical profession. We'll never get that as long as they (rightly) perceive us as a threat to their dominance. But we do need to bridge the gap between chiropractic and research in order to increase the public's confidence in us and counter the arguments about chiropractic's "dearth of good research to prove efficacy."

There's one final step we have to take. We must get the message out to the public. Earlier this year, television stations around the country broadcast news about a JVSR study on chiropractic adjustments and infertility. Never before has there been such tremendous positive coverage of chiropractic research. But it didn't just happen.

First, the WCA and JVSR had to write compelling press releases and distribute them to reporters through wire services. Then, lead researcher Madeline Behrendt, DC, had to make herself available for news filming and interviews. This coordinated public and media relations campaign had incredible results ‑‑ and demonstrated what we could be seeing every month on TV and in the press.

After all, the drug industry gets frequent headlines based on research that isn't half as credible as the research we can do in this profession. The difference is commitment.

The drug industry spends huge amounts of money and effort on research to invent new pills (and often the disease to go along with them). The main impetus of this research isn't simply to prove the efficacy of the drug ‑‑ it's to act as a springboard for publicity. The more research findings, the more press releases can be generated. The more press releases, the more news. The more news, the more business. The more business, the more money.

Let there be no doubt, research means revenue. Building and publicizing the research and clinical science to validate chiropractic will create a new generation of chiropractic patients. It could easily double the number of chiropractic patients in the U.S. and around the world. If you have positioned yours as a scientific, subluxation‑ and evidence‑based practice, you will see a great increase in practice volume.

Next time you think about research, don't think only in terms of some college professor publishing in a dusty, obscure journal. Think about the impact of a culture of research on the profession, the public and your practice. Think about the next Newsweek report, where the list of pros and cons includes lots of benefits for chiropractic ‑‑ but not a single drawback!