AJCC April 2001


April 2001
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The JMPT, Scientific Research & Publication: A Short Story

by Dana J. Lawrence, D.C.

In early 1977, Dr. Joseph Janse, then president of the National College of Chiropractic, Dr. Leonard Fay, who was Dr. Janse’s right hand man, and Dr. Roy Hildebrandt, a pioneer in chiropractic spinography, met to discuss the an idea presented by Dr. Hildebrandt: to establish a rigorous scientific journal which would document the research being accomplished within the chiropractic profession. Dr. Hildebrandt had come to understand that though the profession had a long and honorable record of scientific accomplishment, by and large most of this research was lost to the greater scientific and medical community because most of it had been published within the pages of purely chiropractic publications; these, not being included in any form of nascent international index, were essentially impossible for any interested researcher to locate. Dr. Hildebrandt’s idea was to create journal rigorous to achieve that same indexing. Therefore, the three individuals set about establishing the Journal of Manipulative and Physiological Therapeutics. Its first issue went to press in March of 1978, and the journal began to be be published quarterly.

In its infancy, the journal had some problems obtaining articles. The chiropractic research enterprise, which we have come to take for granted today, was very much in its infancy. There were few formal research programs on chiropractic college campuses, and the early issues of the journal were longer on case reports, reviews and position statements than hard-core research. This would change.

After the journal had been published for 2 years, Dr. Hildebrandt set about trying to get the journal indexed. His attempts included submission both to Index Medicus and to Current Contents, and though my memory is not clear on this, I believe he was rebuffed in his initial attempts to index JMPT. He then studied how chiropractic was presented in the major databases, finding that there were few papers indexed, and almost all were highly negative toward chiropractic. In his opinion, the indexes themselves had an inherent bias toward chiropractic, though not necessarily by design. Thus, when the journal finally was indexed a short while later, it was more than bittersweet victory.

It is important to note that the growth and influence of the JMPT did not occur in a void; it would have been impossible for the journal to become indexed were there not also a concomitant growth in the amount and quality of chiropractic research. Our growth has gone hand-in-hand with the expansion of our research. Thus, we were able to move from a quarterly publication of 300 pages per year, to a bimonthly publication of 420 pages a year and then to 9 times per year, publishing approximately 700 pages of good scientific information per year. We now publish issues in January, February, April, May, June, August, September, October and December; we also have a full text online presence at www.mosby/jmpt, and we foresee further development utilizing the world-wide web.

Today, the JMPT is included in the following international indexes: Index Medicus, Current Contents/Clinical Medicine¨, BIOSIS, Excerpta Medica and EMBASE, the Russian Academy of Sciences, CINAHL and MANTIS. We receive close to 200 submissions per year, and these submissions come from all parts of the globe. Recent submissions have come from the following nations: Norway, Sweden, France, Japan, Russia, People’s Republic of China, Canada, Denmark, Australia, New Zealand. And I should note that submissions come not just from the chiropractic profession. We have attracted papers written by medical physicians, osteopaths, physical therapists, and academics from a variety of clinical and basic science backgrounds. Our editorial board reflects this diversity of background. What is so critical is that all these individuals are helping to disseminate good chiropractic research are opting to use the chiropractic profession to help disseminate their own work. I am hoping that they do so recognizing the quality of the material that we publish.

Chiropractic Research

Let me comment upon the state of chiropractic research. When I was a younger faculty member at National College of Chiropractic, I remember having a meeting with Dr. Janse wherein he challenged members of the Chiropractic Department to take the lead in developing chiropractic research; we had little at that time. Under the leadership of our then research director, we each of us volunteered to get involved in some form of research. Mine involved looking at weight bearing as it related to the presence of short leg. How naive we were then, and this only 16 years ago! We had little money, we operated solely within our own college bounds, we had no computers, we had no technology. But we actually got work done. And as we did so, it became apparent how little we knew, so that our college began to put more time and money into expanding research. This was happening, of course, at other colleges as well.

Today, if you look around, you will find quality chiropractic research at every level of our profession. Much of this is grant funded through various professional (such as FCER) and federal (such as NIH and HRSA) agencies. Not too long ago, this would have been deemed impossible. Today, we have a research center receiving millions of dollars located on a chiropractic college campus. We are presenting our research at international conferences that involve not only chiropractors, but many other medical and academic disciplines as well. We have had a number of grants which have exceeded one million dollars.

We offer, every year, two critically important conferences. One, the International Conference on Spinal Manipulation, allows chiropractic researchers from all over the world to meet and share their findings; the second, the Research Agenda Conference, allows scientists to meet to study how we go about the business of research, to look at the impediments that exist, and to find new ways to address those impediments. By and large, the attendees at these programs are chiropractic researchers and not field doctors, yet there is much to enjoy at each of these conferences, and it would be a most educational way to learn what the latest advances in the profession are.

When one looks over the past 10 years worth of research, one has to be impressed by the breadth and rigor of that work. There have been clinical trials, outcomes and health services research, case series, meta-analyses, basic science studies, reliability studies and so on. These studies in many ways have clarified our science, and in other significant ways, they have muddied it. Where do we need to go from here. First, it is essential that we look at the reliability of the procedures that we use. How reliable a procedure is motion palpation? Leg checks? Radiographic mensuration? Orthopedic testing? The fact is that we do not really know how reliable the diagnostic tests are that we regularly use. Without that knowledge, it is difficult to ascertain if they are valid tests. We need to look at the techniques that we use, and see if the foundations upon which they are based hold up to scientific scrutiny. We need to ask, which techniques work for what conditions under what circumstances? Is there a Òbest techniqueÓ to use for a specific low back problem? We need to look at how we can impact the delivery of health services. For example, some effort has been put into studying how chiropractors in rural areas differ in the delivery of services; the goal here was to see whether the chiropractic physician could act as the main source of primary care in that rural setting.

In truth, we do not always know where our research will lead us. The Harrisons, who were kind enough to solicit this short column from me, have spent a great deal of time and energy applying engineering principles to the human spine and to human posture. They have looked at the idea of the "ideal" spine. As yet, we cannot say where this will lead and what developments may occur as a result of this study, but each paper adds more to what we do know.

Even the fact that we are publishing scientific information at all is significant. For those of us who have entered this profession in the last 10 years, we might take our scientific publications for granted. We have had choice when it comes to our scientific reading. But this was not always the case, and not all that long ago. Last year, I prepared a paper as part of a series of health care forecasting which deal with advances just in scientific publication within chiropractic.1 If we look just at the developments in publication, we can see exactly how far we have come. My list of publishing accomplishments included:

q Overcoming publication bias
q Development of new, credible chiropractic publications
q International indexing of chiropractic literature
q Increased quality of chiropractic scientific publications
q Editorial recognition of chiropractic publications
q Editorial acceptance of chiropractors as scientific experts in both the basic and clinical sciences
q Growth in the number of high quality publications
q Recognition of contributions of chiropractic research to the basic sciences
q Increasing contributions to health sciences research
q Improved internal acceptance of research
q Recognition within established health care publishing
q Increased involvement in electronic and web-based publishing
q The creation of the Chiropractic Research Journal Editors Council
q Government recognition of chiropractic editorial expertise
q Increased value of research publication to the profession

It is this last that concerns me at present. Indeed, there is an increasing respect within the profession for what our research has to offer, and we intrinsically know that it is important to our future, given that we are now living increasing more and more in an evidence-based world. Yet the truth is that by and large we do not support our researchers and we do not support our journals at the level we need to.

This is an old story and I am a highly biased individual. I simply know the need and the risk of our not attending to our own literature. We can’t afford not to take it very seriously indeed.

References

1. Lawrence DJ. Scientific publishing and scholarship. Topics Clin Chiropr 2000;7:39-42