August 2007

Media bias evident within profession

by Dr. Terry A. Rondberg

In his latest "Now You Know" newsletter, Bob Braille, DC, discusses the media's prejudice against chiropractic research. Using the recent report about chiropractic and blood pressure (published in the Journal of Human Hypertension) as an example, Dr. Braille asks the rhetorical question: "How much does the drug advertising money effect the editorial judgment of news services and publications?" and notes that "This transparent lack of responsible journalism just shows how much big drug money can influence what should be autonomous news."

Amen to that! When the drug industry pumps nearly four billion dollars a year into direct‑to‑consumer print and broadcast ads, the media isn't about to bite the hand that feeds it. Next time you read an anti‑chiropractic article in a magazine, skim through it and see how many drug ads fill the pages.

But there's an even more insidious type of media bias that suppresses news of chiropractic research: bias by chiropractic publications themselves! I don't know if it's due mainly to political considerations or just a lack of reader interest, but chiropractic research doesn't get a lot of play in most chiropractic magazines and newspapers either.

How many of you, for instance, read about the study in the Journal of Alternative and Complementary Medicine, that flexion distraction was more effective in reducing low‑back pain when compared to physical therapy exercise programs?

What about the report in the Journal of Vertebral Subluxation Research (JVSR) concluding that a causal link between trauma‑induced upper cervical injury and the onset of vertigo appears to exist, and that correcting the injury to the upper cervical spine through the use of IUCCA protocol appears to improve and/or reverse vertigo disorders?

Or the article in the  Journal of Manipulative and Physiological Therapeutics that describes how dietary modification, parental counseling, and comprehensive chiropractic care may offer a non-invasive approach to excluding and/or managing cow's milk intolerance in infants?

I doubt if more than a couple of chiropractic publications contains even an abstract of these and similar chiropractic research reports. The same goes for chiropractic websites, even those that supposedly focus on research.

One website, for instance, says that "building a research culture" is among its primary goals, yet fails to report on almost all research projects that are not conducted by the organization sponsoring the site. In fact, its section on pediatric research contains only six studies, all but one of which were published in the 1990s.

But the problem of bias against our own research goes further than simply ignoring research reports. Unfortunately, the realm of research ‑‑ which should be totally apolitical ‑‑ has fallen victim to the "partisanship" that infects so many other elements of our profession. Rather than adopt an objective and scientific view of research, some groups and individuals wear blinders that restrict their vision (and their thinking). They are only interested in, and supportive of, research that either they are personally involved in or have a political stake in

For this reason, many of the leading critics of subluxation‑based chiropractic refuse to even acknowledge research on the impact of vertebral subluxation. They don't think subluxations exist, so they don't give any credence to research on the topic. Several publications that align themselves with this camp refuse to even mention reports of subluxation‑based research, despite editorial proclamations that they support chiropractic research!

Far more damaging to our profession is the fact that this same bias is evident in the actions of organizations and companies that develop guidelines and official policy statements used to regulate chiropractic.

Take the recent "Policy Statement on Upper Cervical Adjusting Techniques" adopted by American Specialty Health (ASH), which proclaims that "Upper Cervical Techniques are considered Experimental or Investigational because current scientific evidence has not shown it to be safe, scientifically plausible, or effective."

In addition, this Policy Statement notes that:

1. The clinical benefits of using x‑rays to identify subluxation or determine line of adjustment do not outweigh the known health risks of ionizing radiation and is, therefore, unsafe.

2. Adjusting upper cervical vertebrae to treat chief complaints unrelated to the cervical spine (e.g., lumbar pain) has not been shown to be either effective or scientifically plausible.

3. Leg length checks or thermography used to confirm the subluxation removal or to assess outcomes of care have not been shown to be either effective or scientifically plausible

ASH concludes ‑‑ based on its carefully selected "evidence" ‑‑ that the use of a high velocity, low amplitude (HVLA) thrust adjusting technique by itself, which may be taught as part of an upper cervical protocol, is acceptable if the choice of that technique does not require x‑rays to identify subluxation/ misalignment or to determine line of adjustment/correction; the upper cervical adjustment is not for the purpose of treating complaints unrelated to the cervical spine; and unacceptable, non-evidence‑based methods (e.g., leg length checks or thermography) are not used to confirm the subluxation's removal or assess outcomes

Note carefully that the statement refers only to the upper cervical adjusting technique to identify or correct subluxations. It is apparently permitted to use gross, non‑specific manipulative procedures in the upper cervical spine to treat localized neck pain ‑‑ that's scientific. But, if you are trying to be specific and determine exactly how the upper cervical spine is misaligned, the degree of the misalignment component of the subluxation, whether or not that misalignment has a neurological component, the specific vector needed to reduce it and you are using outcome assessments to determine if you did actually reduce it ‑‑ then you are using experimental and investigational techniques.

ASH is not alone in its obvious bias against subluxation‑centered research. Entities like the Mercy Conference and its successor, CCGPP, show similar partiality, reviewing and accepting only those research papers which fit their pre‑conceived notion of what chiropractic is, or should be.

It's one thing to criticize the mainstream media for prejudice against chiropractic research, but we'd better clean our own pot before we call that particular kettle black.

(Dr. Terry Rondberg is president of the World Chiropractic Alliance and publisher of The Chiropractic Journal and the Journal of Vertebral Subluxation Research. A popular speaker at chiropractic conferences and seminars, Dr. Rondberg is also a frequent guest on TV and radio shows. He has written numerous articles on chiropractic for the profession and the public, as well as several best‑selling books, including "Chiropractic First," "Under the Influence of Modern Medicine," and, with Timothy J. Feuling, the "CBS Malpractice Prevention Program," and "Chiropractic: Compassion and Expectation.")