May 2007

The 'result' of research

by Dr. Matthew McCoy

No one would argue that chiropractic research is a "good thing." Yet, it's sometimes difficult to explain just WHY it is. After all, what benefits do we really get from research? Are you going to change the way you adjust patients after reading that subluxation correction may help reduce the affects of depression, or that chiropractic care might lessen the severity and/or frequency of vertigo episodes?

It's different with medical research, which is primarily directed at figuring out which drugs and surgical procedures are least likely to kill or harm patients (and which might supposedly do some good). If you're an MD and your keep reading research proving that antibiotics are widely overused and are contributing to the creation of 'super bugs' while suppressing normal immune response, you might be less inclined to prescribe penicillin to children with bacterial infections like strep throat. News that some statin drugs used to control cholesterol could cause a potentially fatal muscle‑wasting disease called rhabdomyolys, could convince you to actually suggest the patient change his or her diet.

But what about chiropractic research? As DCs, we are unlikely to discover that adjusting the sixth vertebra is cause for alarm, or that the Sacro Occipital Technique is linked to mad cow disease. Since chiropractic does not involve drugs or invasive procedures (at least not yet!), research is directed toward exploring the impact of subluxation on health and the effect of chiropractic adjustments (or spinal manipulation therapy, depending on the researcher).

While some research may actually affect the way we practice and will hopefully continue to raise the standard of care we provide to all patients, the results of research are less direct in chiropractic than they are in medicine.

Yet, those results can be seen and their influence on the chiropractic profession and the public can be profound.

For example, it was recently announced that couples seeking treatment for infertility were increasingly turning toward alternative health care approaches ‑‑ such as chiropractic. A report published in the April 2007 issue of Australia & New Zealand Journal of Obstetrics and Gynecology noted that about two‑thirds of surveyed couples going to an infertility clinic reported using complementary and alternative medicine (CAM). Nearly half of them said they had "consulted with a complementary therapy provider, such as a chiropractor, acupuncturist, or naturopath."

Actually, the percentage is probably a lot higher, considering the fact that the survey only included people going to an infertility clinic, not those whose use of chiropractic and other non‑medical approaches were successful enough to eliminate the need to visit the clinic.

The research report was submitted to the O&G Journal in December 2006 so the research itself was probably conducted some time in 2005 or early 2006.

There was a similar research project published in 2005, in the Journal of Experimental and Clinical Assisted Reproduction. In that report, 13% of men and 40% of women had used CAM for their infertility. Overall, 19% of patients had used CAM for other health problems in the past. Of patients who had used CAM, 10% thought it had been helpful for infertility, 13% felt it had helped them psychologically and that they had done everything possible, and 22% felt it had helped them to relax.

Now, what happened in 2005 to increase the use of alternative care for infertility and motivate medical doctors to look into the trend?

My guess is that the trigger for both was research published in the Journal of Vertebral Subluxation Research in 2004 on the success of chiropractic in addressing infertility issues. The 12 studies in the series found that chiropractic had positive results regardless of the woman's age, number of years infertile, previous medical intervention or health history including miscarriages, blocked fallopian tubes, amenorrhea, colitis, or trauma.

In the months following the publication of the research, the report was publicized in newspapers, magazines and broadcast media. Television networks picked up the story and ran a syndicated spot about the research and Madeline Behrendt, DC, associate editor of JVSR and lead researcher on this project, was kept busy answering calls from reporters and health writers around the globe.

There's no way to know for sure but it's safe to assume that the world‑wide publicity might have increased the number of people seeking chiropractic and other non‑medical care in their search for a solution to their infertility.

Up to this point, if my theory's correct, the effects of this chiropractic research were very positive. Chiropractors saw more patients and more couples enjoyed the blessings of parenthood. They, in turn, learned about chiropractic's other benefits and no doubt passed on the information to others. The cycle continues.

Which is precisely what caught the eye of medical researchers, who decided to take a closer look. Do you think they conducted their research merely out of curiosity? Were they thrilled to learn that people were looking into safer alternatives before turning to medical treatment?

Obviously not. The UK researchers seemed worried about the trend.

"Infertility patients are a vulnerable group that often seek a non‑medical solution for their failure to conceive," they wrote. They virtually dismissed a total of 105 research reports concerning the use of CAM for infertility and miscarriage, saying that "the studies were generally of a poor quality with no study providing prospective randomised controlled evidence of clinical efficacy for any form of CAM to improve the prognosis for infertile couples. Given this paucity of data, there is great need for properly conducted and appropriately controlled research in this area."

They also commented: "As CAM is used so frequently (unsubstantiated claims of efficacy notwithstanding) there is a clear need for further research on this topic." The reason for this research isn't so that MDs might refer patients to alternative practitioners but that they might co‑opt whatever the non‑MDs are doing. In fact, they note that part of the attraction of CAM is that "Patients often describe an encounter with a CAM provider in terms of someone who was 'really interested,' a person 'who listened really carefully to what I was saying' and 'who seemed to understand how I feel.' From this, it may be offered that traditional doctors would benefit by refining listening and counselling skills ‑‑ an integral part of training, especially in general practice and now recognised as a core skill in RCOG and other specialist training."

In other words, figure out what chiropractors are doing right and then try to do it themselves. Barring that, prove that what chiropractors and other CAM providers do is ineffective.

The Australian researchers said very much the same thing. "Complementary medicines and therapies are widely used by patients with infertility. Health‑care practitioners and fertility specialists need to be proactive in acquiring and documenting the use of these practices. There is a need to provide further information to patients on the use of CMs and therapies. Further research examining the reasons for use of CMs and therapies is needed."

The doctors in both these research projects claimed to have no "competing interests," yet all were affiliated with the Obstetrics and Gynecology departments of hospitals. No competing interests? Unless these hospitals offer a full array of chiropractic and CAM care on an equal basis with medical treatment, there is a definite issue of competitiveness here. They are competing for patients and they're losing them to DCs.

The next step is clear: MDs will research chiropractic and infertility and discover that "spinal manipulative therapy" isn't effective. They'll reiterate their claim that there is a "paucity of data" to validate chiropractic's benefits, repeat the assertion that chiropractic is linked to strokes, and warn patients away from DCs for all but low back pain (and then, only on the advice of the 'physician.').

We've seen this happen with chiropractic for children as well and we're now faced with the very real possibility that chiropractic could be prohibited in children under a certain age. We've seen jurisdictions place a gag order on DCs to stop them from discussing the risks of vaccines.

We could very well see other "regulations" stating that DCs cannot discuss even the possibility of correcting subluxations as a way to address infertility, or ADHD, or asthma, or high blood pressure.

The only way we can stop this inexorable progression of restrictions is to continue to produce more and more chiropractic research to counter these attacks and safeguard our patients' rights to choose chiropractic over medicine.

We need to realize that the result of research isn't necessarily a change in our own practice procedures, but the creation of a protective wall of scientific evidence, behind which we can continue bringing subluxation correction to the world.

Building this wall takes the support of the entire profession. We don't have multi‑billion dollar drug companies funding our efforts, or huge grants from the government. But we do have more than 60,000 licensed DCs who can subscribe to research journals like JVSR, submit case studies for publication, and become RCS Authorized Clinical Investigators.

They say the majority rules. Well, if our profession can't get at least half of its members to do at least ONE of these things, then we'll end up with a profession defined by the medical industry and restricted to the smallest possible cubbyhole of back pain treatment. Actually, it won't be a cubbyhole at all. It'll be a coffin.

(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)