September 2008

What Albert Einstein would say about FCER research

by Dr. Terry A. Rondberg

In a recent open letter to the profession, FCER President Charles Herring, DC, took up the mantra I've been chanting for the past two years: CHIROPACTIC NEEDS RESEARCH.

Dr. Herring stated: "Our first problem is our lack of evidence. While there is a body of evidence that supports the major conditions that chiropractors treat, most of the evidence is not rated at the highest quality because it is difficult to blind the patient or the doctor and it is difficult to do a treatment comparison with a placebo or sham treatment. This affects the quality of the RCTs that have been done and thus weakens our argument that spinal manipulation is effective."

True, he uses different terminology than I do. I don't think of chiropractic as a way to "treat" conditions, and I categorize our care as chiropractic adjustments rather than spinal manipulation. But we agree on the bottom line conclusion that our first problem is our lack of evidence.

Back in May, I wrote: "You and I know this (that subluxations have a negative affect on the state of their health) is true from our first‑hand clinical experience and we do have some research we can point to for corroboration, but we do not yet have the kind of massive and indisputable proof that comes with large-scale clinical outcomes research."

In July of last year, I stated: "I know we'll never convince the media ‑‑ or the public ‑‑ (of chiropractic's effectiveness at addressing a large number of health concerns) until we produce a huge amount of research not just hinting at these connections, but proving them."

And, back in 2006, I wrote: "We lack the kind of research data that would allow us to quantify the global burden of subluxation and be accepted by the world's medical and scientific communities."

I've been harping on this problem for years, and warning the profession that without scientific evidence to "prove" the effect of subluxation on health -- and the efficacy of chiropractic care to correct subluxations -- we risk losing everything we've fought more than a century to achieve. We risk being largely ignored by the public, continually discredited by the medical and pharmaceutical industries, attacked by the media, and disallowed by insurance companies and possibly even outlawed by state and federal legislation.

Now, suddenly, the FCER is hopping on my research bandwagon and stating (somewhat belatedly): "We MUST fund research like our livelihoods depend on it -- because they do. New studies are needed to demonstrate the benefits of chiropractic care with the public, government, and payers of healthcare services. Our lack of evidence is going to allow the insurance industry to continue to deny more and more treatments provided by the chiropractic profession."

The problem is that the FCER still thinks "chiropractic" research involves treatment of back pain and other strictly musculoskeletal conditions. Here is the complete list of all FCER-funded projects for 2007:

*** "Chiropractic Dosage for Lumbar Stenosis"

*** "Chiropractic and Acute Neck Pain: A Practice-Based Study"

*** "Preventive Care of Chronic Cervical Pain and Disabilities: Comparison of Spinal Manipulative Therapy and Individualized Home Exercise Programs"

*** "Does Chiropractic Care Decrease Fall Risk in Older Adults?" (The grant description notes that: "It is proposed that balance, the risk factor for falls, is adversely affected by both musculoskeletal function and low back and lower extremity pain -- which have been found to be responsive in previous studies to chiropractic intervention.)

Where is the research into the affect of subluxation and subluxation correction on diabetes, asthma, multiple sclerosis and Parkinson's disease? What about on infertility, the immune system, attention deficit disorders, otitis media and a plethora of stress-related health problems?

Why is the FCER continuing to ignore the neurological component of subluxation? In fact, why is it continuing to ignore the subluxation itself?

I am convinced that we will never survive as a separate profession if we position ourselves as a quasi-medical therapy for musculoskeletal conditions. Even Dr. Herring admits that: "... there is increasing competition between the chiropractic profession and the physical therapists. They have established doctoral programs and are doing a significant amount of research in universities. There is even talk in Washington that chiropractic should be considered a subset of physical therapy since PTs are more integrated into the education system and the medical treatment model. We are currently in a race to have cultural authority over manipulation, but when it comes to research to support this authoritative position we are losing the race."

A subset of physical therapy? Is that what you want for chiropractic? Do you want your patients to be denied the right to see you and get adjustments unless referred to you by an MD or PT? If you didn't believe me all these years, maybe Dr. Herring can convince you. It can happen!

Do you think the talk in Washington would be different if we had incontrovertible research showing that chiropractic adjustments could help previously infertile women to conceive? Or that they were linked to remission of symptoms for MS patients? That they produced an overall elevation in health ratings for all patients? Or that they were associated with fewer colds and flu in children?

We've already done preliminary research on all these topics. You and I know the effect that chiropractic adjustments can have on nearly every aspect of human health and wellness. We've seen the results of subluxation correction in our own practices; witnessed the "miracles" in our own patients.

Why, then, are some chiropractic organizations still pushing for research on spinal manipulation (a treatment that can be delivered by MDs, DOs, NDs, and PTs) for back and neck pain? Why are we ignoring the neurological component in our schools, our research institutes and our own practices?

Dr. Herring closed his open letter with this warning: "The time for us to act is NOW. We cannot wait any longer. Further delays will only result in our profession falling farther and farther behind in the evidence-based world."

I agree wholeheartedly with that part of his statement. But I disagree when he asks you to make a donation to the FCER. We don't need any more of the kind of research they fund, the kind that will simply push us further into the PT box.

Remember what Albert Einstein said: "Insanity: doing the same thing over and over again and expecting different results." The FCER wants to just keep doing the same thing over and over again, and they expect different results. The same goes for doctors who keep practicing as though they were nothing more than physical therapists for back pain.

Let's break out of the mold. Let's start doing something new, something that will prove to the world that subluxations have neurological as well as musculoskeletal effects and that, as chiropractors, we offer a unique and far-reaching service that can be proven by scientific research.