April 2009

Moving forward by going backward

 by Richard Barwell, DC

Dr. Alvah Byers, a pioneer in biofeedback and a research psychologist, taught me more than he thought I was absorbing. As a chiropractor, I tend to exercise by jumping to conclusions. After all, that was really my training. As a profession, we do this all the time.

Just this morning I had a phone conversation with a DC who was explaining how his technique could access and alter brain function. The explanation was in great detail and while it sounded very logical, without some method of objective measurement and reproducibility, it was really just another exercise of conclusion jumping. Don't get me wrong. I'm not "dissing" the DC or the idea. One of Dr. Byers' teachings was that there is a difference between possible and probable. What the DC said may be possible; but without proof, the probability must be questioned.

When we (Drs. Long, Byers, et al) started doing the studies on the effects of the adjustment on brain wave activity, I had already jumped and said that I expected to see changes. Dr. Byers cautioned me on this and suggested that perhaps any changes might be the result of the people selected, or the room, or some other yet unconsidered factor. I thought he was just being a stick in the mud or worse, someone who was going to find that chiropractic didn't do anything and it was simply a placebo effect. (my secret greatest fear)

His next suggestion made matters even worse. He suggested that we do a Null Hypotheses. I must have given him that dumb stare as he then said, "That is where we prove that the adjustment does nothing!" Oh well, this made me happy (a lot of sarcasm here). I was dumbfounded! I mean, I really liked Dr. Byers (who has since passed away), he was a dear friend, but I just wasn't sure if I should hit him or not. He suggested that we prove the adjustment does nothing? All of a sudden I got very nervous.

When he finally got my attention he explained, "If we set out to prove that nothing happens when you adjust someone, and we are wrong, it means that the adjustment does do something. Then the challenge becomes, one of now knowing that the adjustment changes something, what does it change?" He continued, "Then we can start looking at: How does it change activity? Or, How can we improve the adjustment's effectiveness? But first, we have to go backward (Null) before we can go forward."

Here I was, prepared to jump all over the place and he just sat me down into a chair and said, "Sit still for a minute, and let's look at why chiropractic continues to have problems as a viable profession."

He got my attention.

I know there are many DCs out there in Wonderland who get upset with me using the terms "viable" or "verifiable," and chiropractic in the same sentence but the truth of the matter is that it is exactly the challenge we face.

We continue to attempt to justify chiropractic on the basis of narrative reports. These are known as anecdotes or stories. This form of information gathering doesn't even make it to the lowest rung of the research acceptance ladder, the case study.

I continually hear from DCs using one technique or another that their technique can discover incredible facts about neurological function and because of this, they get better results. When I question them about how they know, I get one of those, "oh you're one of those disbelievers" looks. Listen, I want, I mean I really, really want every one of them to be right; but I also want to stop simply exercising my conclusion jumping and start exercising my brain through reproducible proof that will move chiropractic forward.

Here's something I learned from Dr. Byers. Real research doesn't care about the direction of the results except that they are reproducible. Real research may show that what you did produced nothing and there is value in that knowledge. Or it may prove that what you did produced unexpected results. There's also value in that knowledge. It may show that the patient's narrative doesn't agree with objective findings -- the results are just results. The key is, can we start a care prediction that is greater than chance, based on our research? Not yet, but soon!

So, this is what we know about research and chiropractic. First we have to back up and start with the Null Hypothesis. After 113 years of chiropractic care, we can safely say that there is more than enough evidence (even though poorly gathered) to prove that chiropractic adjustments do change something. Further, and critically important, this something is greater than joint motion; otherwise you can't offer any explanation as to the effectiveness of techniques such as TRT, Network and many others. Now in order to move forward, we need to find out what that "something" is and what it affects. We need to be willing to put our techniques to the test of objective measurement, stop conclusion jumping and through real research move chiropractic forward. Thank you Dr. Byers you were a great friend, to me and to this profession.

(Dr. Richard Barwell is the founder and president of the chiropractic Equity Offices, Inc. program, and has more than 30 years of experience in chiropractic practice. After graduating with honors from Canadian Memorial chiropractic College in 1964, he started a family Wellness Practice in British Columbia. He has since established numerous successful practices, won several awards and guest lectured at various chiropractic institutions. Before establishing CEO, Inc. Dr. Barwell was the director of seminars and programs at Quest and executive director of the Chiropractic Leadership Alliance.)