November 2005

Research in the courtroom

by Dr. David A. Jackson

It's already well accepted in the chiropractic profession (as it is in other health care professions) that research can be a powerful public education and public relations tool. After all, what better PR can we ask for than a front page story in The New York Times stating, "Chiropractic shown to strengthen immune system," or "Subluxations proven to have global impact on health?"

But it can also be an equally powerful tool in the courtroom. In fact, scientific research can help clear a DC of a malpractice charge.

Look at the most famous chiropractic‑related malpractice case in recent history, involving the death of a Canadian woman who suffered a stroke more than two weeks after receiving chiropractic care. Lawyers representing the deceased woman's family entered massive amounts of medical research into evidence in hopes of proving that the stroke was caused by the chiropractic neck manipulation she received. The defense attorneys, in turn, offered what studies they could find to support the fact that chiropractic is so safe that risks are considered negligible.

The entire case became a battle of contradictory research. In the end, the chiropractors weren't able to fully prove their case and the judge deemed the death "accidental," stating that the fatal stroke was caused by trauma, which may have included manipulation of her neck. Since that ruling failed to exonerate the doctor (and, by extension, chiropractic itself), Tim Danson, one of the lawyers representing the chiropractic profession, complained that it "represents a massive miscarriage of justice."

If the defense attorneys had had more definitive research to prove their case, the results would have been different. The case probably would never have gone to court at all and even if it did, the evidence would have been so clear cut that the judge would have quickly found in favor of the DC.

Few of us will ever face this type of high‑profile case that generates such sensationalist coverage, but we may find ourselves facing a judge and jury in a malpractice case involving the "medical necessity" of the care we provided to a patient.

In such cases ‑‑ which are becoming more and more common ‑‑ the patient‑turned‑plaintiff accuses the doctor of providing care that was not needed by "medical standards."

One example of this type of case is adjusting a child to help resolve a common ailment like otitis media. What if, after taking her child to your office, the mother goes to a medical doctor who says that children should never receive chiropractic? She is furious at you for having put her child at risk and charging her to care that wasn't needed. Her next stop is a lawyer's office.

The day of the trial comes. What do you and your lawyer do? You can present a long list of "stories" that talk about the effectiveness of chiropractic on otitis media and even get other patients to testify how it worked for their children.

But to make a true impact, you need to present scientific evidence. Fortunately, there are a few research studies done on this topic that might stand up to courtroom scrutiny, such as a 1997 Journal of Clinical Chiropractic Pediatrics study by Joan Fallon, DC. However, in her conclusion, Dr. Fallon notes that: "This pilot study can now serve as a starting point from which the chiropractic profession can begin to examine its role in the treatment of children with otitis media. Large scale clinical trials need to be undertaken in the field using tympanography as an objectifying measure. In addition, the role of the occipital adjustment needs to be examined." (italics added)

Hardly what a judge would consider definitive evidence.

An earlier study ‑‑ published in a 1996 issue of the Journal of Manipulative Physiological Therapeutics ‑‑ features similar qualifications. While the author states that "this study's data indicate that limitation of medical intervention and the addition of chiropractic care may decrease the symptoms of ear infection in young children," the conclusion also admits that "there were several limitations to this study (mostly because of its retrospection but also, significantly, because very little data was found regarding the natural course of ear infections)."

The plaintiff's attorney would jump on that with both feet.

Without solid scientific proof that chiropractic can safely and effectively help address otitis media, it would be difficult to defend against a case in court.

The same thing applies to other childhood problems such as asthma, enuresis, or infantile colic. You and I may "know" that chiropractic can help children but the judge and jury don't want to hear our opinions. They want hard scientific proof.

Nor is this situation limited to chiropractic for children. Where is the "proof" that chiropractic can help reduce the frequency or severity of colds and flu? What research can you present in court to show that your adjustments for subluxation correction were beneficial to your patients? How do you prove to a jury that your recommendation for regular wellness care isn't a scam?

In chiropractic, it's not enough to say "trust me, I'm your doctor." You have to be able to show patients (and their attorneys, if it comes to that) documented scientific evidence to support what you do in your office.

In 110 years, our profession hasn't been able to compile that kind of irrefutable evidence, despite the efforts of our colleges and research institutions and organizations. We have a few reliable studies showing that we may sometimes be as effective as medical intervention for back pain in adults, but that's a very small box to squeeze ourselves into. Most of us don't want to limit our practice to that one area, yet we don't have enough scientific research to support much of anything else.

That's why RCS (Research & Clinical Science) was formed ‑‑ to do the kind of large scale clinical trial that will form a solid foundation of "proof" upon which we can build a stronger profession. By gathering a world‑class group of scientists and researchers and a large network of field doctors ‑‑ all of whom are IRB‑approved! ‑‑ we will produce numerous studies supporting chiropractic's role in health and wellness. We'll compile the data needed to show the global impact of vertebral subluxation on the world's health and the long‑term benefits of chiropractic adjustments on all areas of wellness and quality of life.

With these published studies in hand, we'll not only get the front page coverage we deserve, but we'll be able to walk into a courtroom confident that we have the "proof" we need to win our case.

I urge every licensed DC to support chiropractic research by becoming an RCS Authorized Clinical Investigator. The rewards you receive will go far beyond helping to put chiropractic on a firm research footing. You'll also benefit from the enhanced credibility and prestige that comes with being an IRB‑approved researcher, and have the unique opportunity to educate hundreds of research volunteers about the benefits of chiropractic care.

(Dr. 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.)