January 2007

Is ACA condemning FCER research as scam?

by Dr. Terry A. Rondberg

During its 2006 House of Delegates meeting in Scottsdale, Ariz., the American Chiropractic Association (ACA) reaffirmed a 1991 resolution that warns against the use of research programs "for the designed purpose of patient solicitation."

I'm assuming this resolution is directed at the Foundation for Chiropractic Education and Research (FCER) and its annual "Patient Appreciation Day," which was started 10 years ago as ‑‑ in the words of the FCER ‑‑ "a way for doctors to strengthen their relationships with current patients, attract new patients, create community awareness, and raise funds for critically needed chiropractic research."

According to the FCER, "Hundreds of DCs hold Patient Appreciation Days in their office as a fun event to draw in new patients, reactivate former patients, and raise funds for FCER's ongoing chiropractic research and education programs at the same time." Obviously, one of the primary functions of the FCER program is to attract new patients.

I'm surprised, however, at the ACA's condemnation of the FCER program, since it also provides financial support to the program and has publicized it over the years. In fact, the 1991 issue of the Journal of the American Chiropractic Association (JACA), published an article about the program, stating: "You can help raise funds for vital chiropractic research while building your patient base by participating in FCER's Patient Appreciation Day program."

Sadly, the PAD program ‑‑ which doctors have to purchase from FCER ‑‑ doesn't permit the doctors to actually involve themselves in the research process. It merely funds the type of low‑back pain studies that have reinforced the mistaken notion that chiropractic is limited to a very narrow range of musculoskeletal disorders.

Of course, the ACA wasn't criticizing the FCER's patient‑building scheme. Instead, it was directing its resolution at RCS (Research & Clinical Science), the private sector research company engaged in subluxation‑centered research that has the potential to expand chiropractic into the wellness arena. After all, the ACA and its allies (namely, organizations like the CCE, FCLB, and NBCE) have fought against anything tainted by "old‑fashioned" chiropractic philosophy for decades. It even went so far as to specifically mention RCS in its press release announcing the resolution, referencing a widely contested article by Stephen Perle, DC which made numerous false claims about the RCS program.

It's particularly interesting that the motion to reaffirm this old resolution was made by the ACA's Insurance and Managed Care Leadership Committee. Why would this committee be so interested in a research program that it would draft such a resolution?

Could it be that having research proving the negative impact of the vertebral subluxation is feared by the insurance industry?

Perhaps the committee ‑‑ one of whose members is Mario Spoto, DC, the ACA's delegate to the CCGPP ‑‑ is anxious to destroy RCS since the research it's doing could completely blow its so‑called (but clearly misnamed) "Best Practices" document out of the water?

Or maybe it's a more personal thing. I've been one of the biggest boosters of the RCS (and have recently accepted the position of CEO for the company) and I've also been one of the most vocal critics of the ACA and CCGPP.

I'm not the only person to see the irony in this action by the ACA.

Gregory Plaugher, DC, e‑mailed a scathing criticism of the ACA's obviously political action. In the e‑mail, he stated it was "disturbing to hear that Dr. Perle's ethical views make their way quickly into ACA policy. Of course he, Dr. Craig Nelson, Dr. Dana Lawrence, Dr. Jay Triano, Dr. Gert Bronfort, and others also have opinions about chiropractic practice and education noted in Nelson et. al.'s Chiropractic & Osteopathy paper ... which basically renounces: subluxation, structure function, "Palmerian tenets," nervous system, primary care ‑‑ pretty much everything taught and practiced in the chiropractic profession."

He continued: "It's really quite shocking that the politicos in ACA actually rely on people like this to define the profession, make guidelines, and represent chiropractic to outside agencies."

Dr. Plaugher knows a lot about research. He used to be associate professor at Palmer College of Chiropractic West, and director of research of the Gonstead Clinical Studies Society. Now, he's the director of research and associate professor at Life University and has a lengthy list of publication credits in respected journals including Journal of Manipulative Physiologic Therapeutics, Journal of Clinical Chiropractic Pediatrics, Chiropractic Journal of Australia, and Chiropractic Technique.

As a researcher himself, he understands more than most the potentially devastating effects of the ACA's action and their continual assault on subluxation‑centered chiropractic. As he told doctors on his e‑mail list: "Get a clue or you'll wake up one morning to 5 visits (without x‑ray), for intermittent pain syndromes (spine only‑no extremities of course), and a profession defined as a dentist for the spine (their words) well integrated under the umbrella of medicine.....oh I'm sorry...this isn't a nightmare...it's reality today."

He also commented that the ACA should "make sure (they) also go after the American Academy of Pediatrics

www.aap.org/pros. The mission of PROS is to improve the health of children and enhance primary care practice by conducting national collaborative practice‑based research."

In fact, the AAP PROS program is very similar to the one conducted by RCS. It consists of 1,953 pediatric practitioners from 719 practices in 49 states, Puerto Rico and Canada, teamed with a research staff at AAP headquarters in Elk Grove Village, Ill., and research consultants from around the country. RCS consists of chiropractic practitioners from around the world teamed with an International Scientific Advisory panel of MDs, PhDs, DCs and lay people.

The AAP program is currently working on a variety of projects, including studies on how practitioners diagnose child abuse in primary care settings, a new way to help parents prevent child violence, and how to improve practice/clinic immunization rates.

The RCS program is currently working on a variety of projects, including studies on how subluxation correction may be beneficial in addressing specific health concerns, boost the immune system, elevate overall health and well‑being, and reduce health care costs.

PROS practitioners report they enjoy being part of an overall research effort that routinely solicits their input on study questions and study designs (protocols and materials) and that examines questions relevant to the day‑to‑day practice of pediatrics. They also tell us that parents view research involvement on the part of the pediatric practice in a very positive light, and are eager to fill out questionnaires when they are a part of a study.

I can say the same thing about RCS doctors!

Do you think the pediatricians involved in the PROS program turn research volunteers away if they want to become patients? Of course not. Although the primary purpose of both PROS and RCS is to generate vital research, one result for the doctor may be increased patient volume. Or, as the FCER puts it, the research is ‑‑ secondarily ‑‑ "a way for doctors to strengthen their relationships with current patients, (and) attract new patients..."

The ACA has given $6 million to the FCER and fully endorses its Patient Appreciation Day program, despite the emphasis on attracting patients. Yet, the ACA's insurance committee uses an article by a well known opponent of subluxation‑centered chiropractic as the excuse to condemn the RCS program, which is already producing incredible research results (be sure to read the article by Dr. Bob Blanks in this issue of The Chiropractic Journal).

As Dr. Plaugher says, this isn't a nightmare, it's today's reality. Yet, we can change reality by acting quickly and decisively to save subluxation‑based chiropractic. We have to gather together to support efforts that promote traditional chiropractic and fight ‑‑ and fight hard ‑‑ against those who are trying to destroy it.

Act NOW

Here are three suggestions for immediate action on your part:

Make your $$$ count. Take a close look at the organizations and companies you support with your dollars. Are they your allies or your enemies? Do they share your vision of chiropractic? If not, why in the world are you aiding in your own destruction? Withdraw support from any college, association, practice consultant, or company that doesn't support you and subluxation‑centered chiropractic. Put your money where your principles are.

Talk among yourselves. Find like‑minded doctors in your area and gather together to lend each other mutual support. Hold "philosophy nights" or invite guest speakers to special meetings. Follow the lead of the extremely successful "Meet Up" movement (use Internet social networking sites like meetup.com to organize these meetings). There is power in numbers and we all need to know we're not alone.

Fight back. Write letters to organizations like the ACA to protest their campaign against chiropractic. Write letters to major chiropractic publications as well as to your state organization newsletters. Don't be the silent majority. Speak out and let others know where you stand!

Action isn't always clear. It is now. Silence may be golden at times. This isn't one of them. Doctors, you hold the profession's future, literally, in your hands.