A dialogue on supporting
chiropractic research

The following is a dialogue spurred by an article published in The Chiropractic Journal earlier this year. Following Dr. Dana Lawrence's letter are responses from Dr. Matthew McCoy and Dr. Christopher Kent.

Researchers are not the enemy

by Dana J. Lawrence, D.C., Editor, Journal of Manipulative and Physiological Therapeutics (JMPT)

I want to commend The Chiropractic Journal for Dr. Matt McCoy's article written in support of chiropractic research ("The role of science in chiropractic: a time for change." The Chiropractic Journal, January 2003.)

At the same time, I wish to offer a few comments on some of the issues Dr. McCoy raised in his article, and comment as well on a second article in the journal ("Cardiac function, SIDS, and the upper cervical spine," by Christopher Kent, D.C.) which dovetails with the McCoy article.

There is little question that the future health of the chiropractic profession will depend in part upon the strength of the research it creates. Whether any of us like it or not, we are living in an evidence‑based world where claims must be subjected to scrutiny.

There is desire to know that what we do does confer benefit, and this must go beyond whether we simply think this is the case. I am happy to see The Chiropractic Journal adding its voice to the many others who are attempting to bring this issue to the chiropractic public.

Dr. McCoy notes how little money and how few people we have who are devoted to research. Despite this, we have been quite successful in developing an infrastructure, which though small (70 full‑time researchers), has been quite effective in its accomplishments.

There is no sense in decrying the disparity between medicine and chiropractic; it is what it is, and the only people who can do anything about it are right here among us. This is one reason our researchers require our support. And quite frankly, they do not often receive that support; instead, they are seen as the people working to harm our profession. Their work is seen as a threat instead of a benefit. Even when we have negative results, that information helps us to manage our patients, which should be our first consideration.

I am also happy to see Dr. McCoy state that subluxation‑based chiropractors should develop intolerance toward chiropractic instructors and leaders (and why not field doctors as well?) who espouse rhetoric that science is not essential to the development of subluxation‑based chiropractic.

Ah, but there is the rub. Dr. McCoy has inadvertently set up an adversarial position -‑ that there is some difference between subluxation‑based chiropractors and other chiropractors when it comes to research. May I please state that good research is good research, regardless of who does it? We do not need such an artificial division in our ranks.

Let us, regardless of our philosophical beliefs and our practice characteristics, simply agree that we should support our research efforts, that we should become conversant with the language of research, that we should look to that research, regardless of who wrote it, as a potential benefit to us.

I am the JMPT editor. I have, in the past, been accused of not publishing "subluxation‑ based" research. I am not sure what that means. Further, I can only publish what I am sent; ergo, I am not being sent what my critics perceive as "subluxation‑based." And whose fault is that?

As it stands, our profession is not supporting intellectual scientific efforts. Our members do not subscribe in any significant numbers to our scientific journals, and as a result in the last few months three of our journals ceased publishing.

Science is often seen more as a means to support what we already believe rather than as a means of change. New research is published, but does not enter our lexicon or our practice. Oh, we get upset when a negative study gets some press, but we don't seem to care about the other papers we publish.

We need to move beyond this sectarian strife. This brings me, respectfully, to the short paper by Dr. Kent. Though the paper is devoted to discussing a recent article from Germany addressing changes in cardiac function after mechanical irritation of the upper cervical spine (Koch LF, Koch H et al. Heart rate changes in response to mild mechanical irritation of the high cervical spinal cord region in infants. Forensic Sci Int 2002; 128:168), in the article Dr. Kent wonders why a second paper, by Schneier and Bums (Schneier M, Burns RE. Atlanto‑occipital hypermobility in sudden infant death syndrome. J Chiropr Res Clin Invest 1991;7:33) did not receive the notice he felt it should.

He states: " Several compelling questions remain unanswered. Why was the Schneier and Bums study ignored by the chiropractic research community? Why did it take a group of German medical doctors to explore this phenomenon? Why aren't our college research departments and research organizations pursuing such studies? Where is the NIH money?"

There is implied criticism here and an adversarial stance. Given the fact that we have only 70 people devoted to research, what does Dr. Kent think our researchers ought to do with regard to the Schneier paper? Drop their own research to follow where he believes they should go? This is not how research works.

Our researchers go where their own interests take them, just as Schneier and Bums did. It is not our researchers responsibility to study what any single person thinks they ought to study. Further, given there are so few researchers, isn't the more important question not why the study was ignored by our researchers but why it was ignored by our 60,000+ practitioners?

Where are they in all of this? They are not reading our literature. Why are we asking our researchers to study what we think they should study? That is up to them. If we wish to see such a study, we can do it ourselves, provide the funding, and find some way to make it happen. But we cannot expect 70 people to address each and every research question that we feel is important. Research is a human enterprise.

I would simply like to see all of us, regardless of chiropractic stance, support the efforts of our researchers and endeavor to understand the nature of research and how it can benefit us. To that end, I thank The Chiropractic Journal for raising the issue.

Pragmatism must win out

by Dr. Matthew McCoy, Editor ‑‑ Journal of Vertebral Subluxation Research    

First, I want to thank Dr. Lawrence for taking the time to respond, as I am quite aware of how busy he is and it is a compliment that he took the time he did to write such a thoughtful letter.

Secondly, I want to take this opportunity to publicly thank Dr. Lawrence for all his assistance during the past several years as I began my career as an editor. While he may not realize it, he has served as a mentor in many respects through his writings as well as through the knowledge I gained by attending the Research Journal Editor's Council meetings and the personal help he has given when I didn't know who to ask about something.

I mention these things not only to thank him, but also to illustrate that it is just this type of mentoring that is so badly needed by junior researchers and junior editors within chiropractic research circles. Many could learn by his example.

Dr. Lawrence voices concern that our researchers often do not receive the support they need and deserve and that their work is oftentimes "seen as a threat instead of a benefit." I agree. And to shed some further light on this I would add that I believe that many within the profession view the researchers as being the "police" of the profession or even more descriptive the "Internal Affairs" department of the profession. This view is tied to the many instances where the research has been selectively used to harm chiropractors through reimbursement, malpractice and board actions. This is an area that needs fixing if trust is to be rebuilt. The problem is that this seems to be where the money is to be made for some chiropractic researchers.

Dr. Lawrence asserts that there is no difference between subluxation‑based research and any other type of chiropractic research and requests that we not make such artificial distinctions. On the whole I agree with him; however I am also acutely cognizant of the reality and have to be pragmatic about it.

For example, it is my opinion that the ACC Paradigm allows for the mutual coexistence and tolerance between all shades of the spectrum of philosophical and practice characteristics within the profession. However, others clearly do not see it that way. These "others" many times hold positions of authority within the chiropractic educational, research and political structure and attempt to use those positions and power to force all chiropractors to fit the version of chiropractic they feel is correct. It is this behavior that creates and feeds these distinctions and fosters the disunity. It also hampers the development of our research infrastructure.

As for the issue of journals and the crisis facing them I can only say that I share Dr. Lawrence's concern. I think we need more journals not less and this issue lies solely in the hands of the individuals within the profession as they are the ones who do not subscribe to the journals. I would have to go further and say that the cause of this lies in the hands of the instructors at our educational institutions who do not use the primary literature in their lectures to our future chiropractors. If they did, the students might develop a better appreciation for it and subscribing to and reading scholarly journals on a regular basis would be second nature to them.  

Dr. Lawrence discusses some issues raised by Dr. Kent in his article in the same issue of the Journal. I agree 100% with Dr. Lawrence's contention that researchers should be allowed to pursue what interests them. Being on the faculty of a University, I deeply appreciate this point and this is an inherent aspect of academic freedom and freedom in general.

However, there are also times when a directed and concerted effort is necessary. We did not build the atom bomb because a few researchers sat around examining their navels. Bell Labs did not accomplish what it did because people were working on their pet projects. Innovation was needed, people and talent were gathered and they were compensated for devoting their time and talent to a project. I learned early on the reality of attempting to make a living in this profession by doing research and teaching. I also agree with Dr. Lawrence that in this regard: "if it is to be it is up to me" and it is this reality that keeps me in the game.

Again, I thank Dr. Lawrence for his letter, his thoughts and his dedication to research in the profession.

Scholarly criticism not meant as adversarial

by Christopher Kent, D.C.

I thank Dr. Lawrence for his letter. I agree that our research resources are very limited, and that field support of our scientific journals has been disappointing. On a personal note, I commend Dr. Lawrence and the editors of other journals for their professional commitment.

It saddens me that Dr. Lawrence found my comments "adversarial." Criticism is a vital element in the scholarly process. It extends beyond challenging the technical aspects of scientific papers. Scholarly criticism includes addressing our research priorities, and discussions on how our limited resources might best be allocated.

Of course, researchers will pursue those items of interest to them. However, funding organizations play an important role in determining research priorities. Solicitations seeking investigators to conduct research addressing specific problems are commonplace. Furthermore, institutions that hire researchers may designate the nature of the projects to be completed.

In a profession strapped for both talent and money, it seems logical that researchers and funding sources would focus upon issues that are likely to have significant impact on clinical practice. My remarks were meant to suggest that there are exciting areas of research that are not being attended to. Some may be due to disinterest on the part of the research community. Others may be due to a lack of available funding.

To me, the relationship between subluxation of the high cervical spine and sudden infant death syndrome deserves further investigation. Thankfully, there are those in the profession who agree, and are seeking funding to so. I wish them well.