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September 2006

Research credibility depends on messenger as well as message

by Dr. David A. Jackson

Last month, I received a message from an excited DC who wanted to alert everyone to an interesting comment by William Sears, MD and Martha Sears, RN, who run the popular pediatric website, AskDrSears.com.

The short but important statement made on their website that elicited so much excitement was: "I firmly believe that chiropractic adjustments to the skull and neck can improve middle ear drainage and decrease ear infections."

Of course, similar statements abound on the Internet. The website "Healthy Child" has a full page devoted to the benefits of chiropractic for ear infections. Ivillage.com mentions it as well, and includes some very impressive statistics. The ICPA (International Chiropractic Pediatric Association) talks about it extensively and, of course, the World Chiropractic Alliance and The Chiropractic Journal have posted numerous articles relating to the topic.

What, then, makes the brief statement from the Sears site so special? In this case, it's not the message, but the messenger.

The Sears are medical professionals who have been practicing pediatric medicine for more than 30 years. They've written over 30 pediatric books and articles in parenting magazines, and have appeared on more than 100 television programs such as "20/20," "Donahue," "Good Morning America," "Oprah," "CBS This Morning," the "Today Show" and "Dateline."

They're not chiropractors "selling" chiropractic (as in the case of the ICPA, WCA or TCJ) and they're not lay people (Healthy Child and iVillage). They're "real" doctors and their opinions on health carry far more weight than that of the rest of the world.

That may not be fair, or even smart, but it's the way things are.

The same is true for PhDs. Florida State University noted: "Whether in practice or policy, the PhD is a prerequisite for credibility and competency." On one UK‑based grad school website, a PhD is quoted as saying: "My PhD has given me credibility in both the academic and commercial world."

When it comes to medical research, if you don't have an MD or PhD after your name, you're just Joe Schmo giving your personal opinions.

That's why it's important for chiropractic research to be conducted either by or in association with non‑chiropractic scientists if it is to have an impact on society.

A research paper produced solely by chiropractors will get attention within the profession and can lead to great improvements in our understanding of the way and extent that adjustments work, on various techniques we can incorporate, or our clinical care decisions. But the public isn't going to pay a lot of attention to them. There are exceptions, of course, such as the huge splash in the mainstream media concerning the research on chiropractic and infertility conducted by Madeline Behrendt, DC.

In general, though, the scientific media tends to ignore chiropractic research conducted by chiropractors. There is just no built‑in credibility at this point.

We meet the same problem when trying to publish chiropractic research in non‑chiropractic journals. JAMA and the NEJM aren't going to give much weight to an article submitted by a couple of DCs. Put that same information into a report developed by a panel of MDs and PhDs and you're sure to get at least a thorough review.

Let's look at the preliminary research that has already been conducted on children's ear infections.

In almost every study, the results have been profound and positive. The research referenced on the iVillage page, for example, showed that 93 % of all episodes of otitis media treated improved with chiropractic care. Seventy‑five percent of the cases improved in 10 days or less, and 43% with only one or two adjustments (J Manipulative Physiol Ther. 1996 Mar‑Apr;19(3):169‑77. )

Why, then, don't all parents rush right to their chiropractors when their kids start having ear problems? Could it be that the researcher, RM Froehle, was a DC, not an MD? If the researcher had been William Sears, MD ‑‑ the famed pediatrician as seen on Oprah ‑‑ the findings would have been blasted in headline type over every newspaper in the country and the networks would get into a bidding war to lure Sears before their cameras.

That's what we have to make happen.

That's why Research & Clinical Science (RCS) put together an interdisciplinary panel of researchers. Although the chiropractic member of the RCS International Scientific Advisory Board ‑‑ Christopher Kent, DC, JD ‑‑ is vital to ensure that it has strong chiropractic input, the rest of the panel is made up of PhD researchers and MDs (and one MD/DC). The panel's diversity is further extended by a nurse and a professor.

Care was taken to select researchers who would not display overt bias against chiropractic, but otherwise the panel members are free of any overt connection to chiropractic that might be called into question by our detractors. Critics can hardly claim that James Fallon, PhD, Professor, Department of Anatomy & Neurobiology, University of California, Irvine, College of Medicine is a chiropractic shill. Or that Margaret Ames, PhD, a nationally recognized expert in health promotion as well as disease prevention communication activities who works in a high level US government health care agency, is trying to "sell" chiropractic to the public.

And since the program is headed by Robert Blanks, PhD, Professor in the Department of Biomedical Sciences at Florida Atlantic University and a past Professor of Anatomy and Neurobiology at the University of California, Irvine (who spent two years at the Max Planck Institute for Brain Research in Frankfurt, Germany and two years in the Department of Anatomy at Harvard Medical School), credibility is close to being bullet‑proof.

When the data collected by hundreds of DCs around the world is analyzed by this panel of objective scientists, the results will have an inherent trustworthiness and authority. The scientific community will be forced to accept it as legitimate (even though some will do so reluctantly) and the media will find it difficult to ignore. When "before and after" care comparisons are made, data will reveal the impact of chiropractic adjustments on a wide range of people.

Since almost every major research study done so far has shown chiropractic has tremendous benefits, I have every reason to think the RCS program results will confirm and expand on those earlier findings. But, because the analysis is being done by non‑chiropractic scientists with the vaulted "PhD" and "MD" after their names, the impact of the research will spread like ripples in a pond to reach even the further shore.