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)