June 2006

Professional prejudice rears its ugly head

by Dr. Terry A. Rondberg

I have a confession to make. I'm prejudiced. I think, to some extent, we all are. I'm not talking about being racist or anti‑Semitic. I'm talking about pre‑judging something before you really know the facts about it.

I do it all the time when it comes to drugs. If I read an announcement in the paper about a new "wonder drug" that promises to cure cancer or diabetes or the common cold, I snarl in disgust. Without knowing anything about the drug or the research done on it, I'm pretty sure that the announcement is the product of a drug company's PR department and that the pill will ultimately offer little or no benefit. I assume the drug company paid for the research and that the FDA ‑‑ which receives most of its funds from the drug industry ‑‑ will approve it without a second glance.

That's prejudiced, although it's justifiable given the history of the drug industry.

But when it comes to chiropractic, I try not to pre‑judge any news I hear. If I get a press release from National or Northwestern College or from the American Chiropractic Association, I try as hard as possible not to assume it's going to be supportive of chiropractic medicine. I admit that when a press release arrives from the International Chiropractors Association or the Federation of Straight Chiropractors and Organizations, I am more inclined to read it with interest, but I still try not to make assumptions before I learn the facts.

Thankfully, I'm not alone in my effort to put aside prejudices when it comes to our own profession. Over the years, I've heard from a great many doctors who said they weren't subluxation‑centered but read The Chiropractic Journal with an open mind and learned a great deal from the experience.

That's why it still shocks me when I encounter someone who immediately dismisses (or even criticizes) a chiropractic program without knowing anything about it, just because it comes from "the other camp." It's particularly astonishing when that "someone" is a chiropractic leader.

A recent case in point was an incident that occurred in late April at the "Symposium on Evidence Based Healthcare in Contemporary Chiropractic Practice" that was held in New York. Although I wasn't able to attend the Symposium, I've had reports on what was said and it was disturbing to say the least. Apparently, Scott Haldeman, MD, DC, chose to use the event as a platform to criticize RCS (Research & Clinical Science), the private‑sector research program that's compiling a massive database on the effects of vertebral subluxation and chiropractic care on wellness.

Constructive criticism is a good thing but it was clear that Dr. Haldeman had pre‑judged RCS and was criticizing it without even knowing the facts about it. Our "leaders" ‑‑ even if they're medical doctors as well as chiropractors ‑‑ should be above that kind of bigotry. I realize that Dr. Haldeman has aligned himself firmly in the chiropractic medicine camp, serving as chairman of the World Federation of Chiropractic's "Research Council" and as chairman of the Mercy Steering Committee. But he's also recognized as a proponent of objective, scientific research.

Where was his objectivity when he blasted RCS for a lack of scientific protocols? He said he hadn't seen any information on the protocols used for the RCS program. Obviously, he'd never looked for them since Robert Blanks, PhD, one of RCS's founders and principals, discusses them in detail on the RCS website. If he couldn't locate them there, he could have simply asked for them or spoken with Dr. Blanks. He did neither. According to Dr. Blanks and the other RCS leaders, Dr. Haldeman has never requested any material on RCS or spoken to anyone about the program. Yet, he felt he was qualified to judge the legitimacy of the program. On what basis did he judge it? Was it his well known disdain for subluxation‑based chiropractic in general? Or, his personal animosity toward me, since I'm one of the most enthusiastic boosters of RCS?

His other criticisms of RCS were equally unfounded. He implied there was something unethical about the fact that RCS was a private‑sector, for‑profit research company. Anyone with any knowledge or experience in research knows (or should know) that the majority of all health‑related research is done by or funded by for‑profit companies. Drug companies, for‑profit hospitals, research institutes and schools, medical device manufacturers, and many other private sector firms engage in legitimate research. Even "non‑profit" status can be a bit disingenuous. The Mayo Clinic, which took in $5.6 billion in 2004, has a "non‑profit" status. Of course, so does Blue Cross and Blue Shield. Does having a non‑profit status automatically make research purer or more ethical?

According to the American Association for the Advancement of Science: "The private sector is also increasingly involved in earlier‑phase basic research, as a new generation of medical treatments develops on the basis of more specifically targeted genetic, biochemical, and physiological interventions. These research interests are being pursued both in house and in collaboration with other institutions. A recent survey of biomedical firms found that 58 percent were engaged in research collaborations with academic institutions."

When drug companies do medical research, they know they'll make billions of dollars back in sales when the drug reaches the market (and they only pursue those that will make billions). RCS doesn't manufacture drugs to sell to the public, so the research has to pay for itself. How does Dr. Haldeman suggest we fund this type of massive chiropractic research effort? Is he willing to put up $250,000 to defray the costs?

For years, our educators and researchers have lamented the fact that chiropractic has produced relatively little research, partly due to a lack of money to conduct it. Our schools are struggling to give students a basic chiropractic education and can't be expected to fund a multi‑million‑dollar research program.

We have two choices. We can just give up on the idea of producing the scientific evidence to prove the effect of vertebral subluxations on health. Maybe Dr. Haldeman wouldn't be too disappointed with that approach, but the vast majority of chiropractors ‑‑ those who recognize the subluxation as a detriment to health ‑‑ would suffer. In time, they'll be restricted to "treating" low back pain in adults and limited to six‑to‑twelve visits per patient. That's what our research so far has supported.

The other choice is to try something innovative (for chiropractic anyway). Private‑sector research paid for by thousands of doctors around the world who collect the data from volunteers. With each doctor paying as little as $149 a month, the program can produce an incredible wealth of research (and each doctor enjoys the further benefit of introducing chiropractic to hundreds of volunteers, many of whom will choose to remain in the program as paying patients).

Albert Einstein once said the definition of insanity is "doing the same thing over and over again and expecting different results." Well, we have been doing the same thing over and over again for more than a century and there's no sense in expecting that all of a sudden we'll get different results. We haven't been able to produce the kind of research we need and if we don't try something different we never will.

There is absolutely no reason to fault RCS because it is a "for profit" organization. Dr. Haldeman gets paid for doing his job. Chiropractic colleges make a profit from tuitions and fees. Researchers ‑‑ even those working in non‑profit institutions ‑‑ receive salaries, grants, stipends and other financial compensation for their work. It's hypocritical to say RCS is somehow tainted because its principals may someday actually make money from the program or because doctors bring in new patients because of their participation as Authorized Clinical Investigators.

The last of Dr. Haldeman's criticism was that RCS couldn't be legitimate because it hadn't announced the name of the Independent Review Board which thoroughly examined and approved the program. It didn't seem to matter to him that the IRB is, as the FDA put its: "an appropriately constituted group that has been formally designated to review and monitor biomedical research involving human subjects ... and ... is subject to the Agency's IRB regulations when studies of FDA regulated products are reviewed and approved."

When a college is accredited by an accrediting agency recognized by the federal government, it is presumed to have met certain educational standards. This might be a regional accrediting body or a specialized one, like the CCE. But the fact that the agency was recognized by the federal government is enough to give the accreditation validity and credibility.

While many IRBs are constituted by and affiliated with specific colleges or medical institutions, many are private companies that work with a variety of research entities. There is nothing inherently "better" about an institutional IRB or a private IRB. The Johns Hopkins Bloomberg School of Public Health, for instance, works with two of its own on‑site standing Institutional Review Boards AND a private IRB that acts as a third IRB when reviewing certain studies.

Does Dr. Haldeman doubt that RCS actually is IRB‑approved or does he want to know the name of the IRB in order to contact them and try to turn them against RCS with his unfounded accusations and prejudiced views? Anyone who has taken time to look at the list of world class scientific researchers serving on the RCS International Scientific Research Advisory Panel can have little doubt of the program's legitimacy. Why would so many MDs and PhDs willingly associate with a fraudulent program?

I think it's time for all of use to examine our prejudices and resolve to base our criticisms on the facts, not on our professional biases or personal animosities. If anyone can't extend their colleagues that minimum courtesy, they should refrain from displaying their bigotry in public and trying to pass it off as objectivity.