August 2008

Is research worth working for?

by Dr. Terry A. Rondberg

We all want lots of things out of life -- and our profession. On a personal level, it's a very individual list. But, when it comes to chiropractic, we all want respect from the medical community, a good reputation with the public, and the scientific research that will validate what we do.

Yet, too often, when we finally get what we want, we don't appreciate it. I've had successful friends who worked years to save enough money to get a luxury car, and then not bother to service or maintain it. After a while, when it starts to malfunction, they blame the car and trade it in.

It's the same thing with our profession. I've watched doctors finally get involved in an important research project that they say they've wanted for years. Then, they fail to devote the needed time and effort to it or even to follow the proper protocols. Before long, problems arise and they fault the program and want to chuck it for something else.

The program I'm thinking of in particular is a well-known global, population-based research effort that's been thoroughly evaluated and approved by an independent Institutional Review Board (IRB). So stringent are the standards for this research program that each clinical investigator is vetted beforehand and must receive IRB approval before seeing a single volunteer.

In addition, each doctor must successfully complete the National Institutes of Health course on "Human Participant Protections Education for Research Teams." The intensive online course covers such vital topics as ethical principles and guidelines that should assist in resolving the ethical issues inherent in the conduct of research with human participants; the use of key ethical principles and federal regulations to protect human participants at various stages in the research process.; a description of guidelines for the protection of special populations in research; a definition of informed consent and components necessary for a valid consent; a description of the role of the IRB in the research process;  and the roles, responsibilities, and interactions of federal agencies, institutions, and researchers in conducting research with human participants.

Obviously, this is a serious research project demanding a serious commitment from doctors wanting to participate in it.

In fact, each doctor signs an agreement pledging to follow all of the procedures and protocols laid down by the project. This includes, among other things, having every research participant sign and properly submit an appropriate, IRB-approved consent form. The agreement clearly explains that if doctors don't follow the rules to the letter, they can be excluded from the program without a refund of their membership fees.

What's shocking is the fact that, despite the signed agreements, several doctors didn't bother to follow those rules! Instead, they jeopardized their own IRB approval as well as the entire project. Then, when the IRB stepped in to prevent this violation of the rules, the doctors blamed the program and wanted to toss it, just like they would if their car had broken down due to their own neglect.

Unlike a car, however, our profession's vital research isn't a commodity we can dispose of and replace at a whim. We need to take research very seriously in chiropractic, since it's the only thing that will finally allow us to earn the other things we want, such as the respect of other health care practitioners and a good reputation with the public. We need to be willing to pay the price for having legitimate subluxation-based research conducted on a large scale, and we have to be willing to take proper care of that research effort just as we take our car in for routine servicing.

If anything's worth having, whether something material like a car or personal like a career -- OR a scientifically validated profession -- it's worth working for. We can't expect others to put in all the effort so we can enjoy the benefits.

When it comes to research, that means we ALL have to get involved in research in one way or another. Individually and collectively, we need to take responsibility for putting out the effort and supporting the process needed to accomplish the goals.