This edition focuses on creating a relationship between the chiropractic technique and research worlds. While sometimes each world sees the other as adversarial, suggestions are made to facilitate communication and greater mutual growth.
Can the Chiropractic Technique and Chiropractic Research Worlds Be Mutually Supportive?
Before I begin I wish to offer the disclaimer that these are my own limited perceptions and may be inaccurate. This is not intended to impugn the character of any chiropractic technique or chiropractic researcher in any way.
The Purpose of Research
Chiropractic Technique World: The purpose of research is to prove the efficacy of a chiropractic technique and the validity of its methodology and procedures.
Chiropractic Research World: The purpose of research is to discern the “truth” about chiropractic methodology and procedures; however, their “employer” or personal bias can affect this “truth” directly or indirectly.
How these individual worlds see each other:
The chiropractic technique world believes research can be used to discredit and invalidate their chiropractic technique’s foundation and basis; The chiropractic research world believes that the chiropractic techniques are focused on self-preservation and financial growth, and that the techniques are fearful of scrutiny and see research as a threat to their self professed claims.
What has come across to me as I have been immersing myself into both these worlds is that there is a significant schism between the two groups. Misunderstandings and misconceptions often lead to conclusions that create disharmony at a time for the chiropractic profession when harmony is most needed.
Chiropractic Techniques Limit Research:
a. They fear failing to convey their technique’s success into the
“language of research”
b. They don’t understanding the research terrain or “lingo”
c. They don’t know how to “scientifically” prove their assertions and
d. They feel “research” distorts the art of chiropractic and vitalism
cannot be measured in a “linear” way.
e. The peer review process, multiply necessary submissions and scrutiny
are very intimidating for novice researchers.
Although research studies attempt to search for the “truth”, there are
specific difficulties with any form of research. Sometimes this is due to the
misconception by chiropractic techniques that research outcomes can be viewed
as either “positive” or “negative.”
What chiropractic techniques must understand for the chiropractic to flourish
is that ALL research legitimizes chiropractic and most specifically, a
chiropractic technique’s integrity.
ALL research findings are essentially “good” findings and studies that do not
“prove” the legitimacy of a specific chiropractic technique can still be of
value by illustrating:
1. Problems in study design
2. Problems with the tester or testee
3. Alternate interpretations and definitions of the research
4. That what was thought to be a reason for a specific chiropractic’s result
could be due to an entirely different mode of action.
5. That the positive outcome to therapy could be found to be due to another
indirect aspect of the care.
6. That what was thought to be a diagnostic or treatment protocol of a
chiropractic technique could turn out to be not effective.
Chiropractic techniques need to understand that all outcomes to research studies show ethics, sincerity, and responsibility. Sometimes research studies might show that a chiropractic technique’s procedure or some methods are questionable, at best or invalid, at worse. However, because of all the difficulties of performing and interpreting research, often times a technique’s procedure or methods will be called to question, sometimes unjustly so.
This relationship between chiropractic techniques and research is paradoxical. If unbiased research were performed by a chiropractic technique, then the chiropractic research world would look at the chiropractic research world as having ethics, sincerity, and responsibility. If on the other hand the findings of the study are used to discredit a technique in the general chiropractic community or in society, then understandably, techniques will be hesitant to put themselves in a difficult and awkward position.
The current trend between the research and technique chiropractic worlds has only come to the forefront in the past few decades. With the advent of the Journal of Manipulative and Physiological Therapeutics and advances in chiropractic research in the late 1960s, the chiropractic research world has entered a new phase of development.
From 1930 – 1950 Major M. B. DeJarnette, DC pleaded with the chiropractic profession to research its diagnostic methods and treatments. Unfortunately, he himself presented his own documented research in his own texts rather than peer reviewed journals.
Typical to the chiropractic technique world until recently, most descriptive chiropractic technique texts were anecdotally based. Often times statements in these texts would not have to be justified or referenced to any literature. Chiropractors have been quite happy with this method of information sharing, much to the consternation of the research world. In fact most of those chiropractors practicing in their offices are only interested in only what will directly help them help their patients.
What we must understand is that research can directly help chiropractors by sharing with them advances in healthcare. Hopefully, chiropractic techniques will be modified with updated findings. At the same time it is essential that the research world supports and encourages the chiropractic technique world’s efforts.
I have found that the majority of technique leaders are sincere about their discoveries and feel strongly about their methodologies and procedures. I have also found that researchers are often offended by what they perceive is a lack of rationality and tend to see the technique leader’s motivations as financially driven instead of intuitively driven, For our worlds to grow and flourish we would do well to look at what is best in each and try not to focus on the faults.
Bill Meeker, DC, MPH the Director of Research at Palmer Center for Chiropractic Research notes that, “I would point out to both camps that technique developers are very often following a scientific process at the beginning and this should be recognized by researchers. I would also point out that many technique developers stop the scientific process before they should, simply because they don’t know any better and are satisfied with less than good evidence. So, both worlds are on a continuum.”
Charles L. Blum, DC
Sacro Occipital Technique Organization (SOTO) -USA