October 2001

Research Agenda Conference VI:

Advancing the Science of Chiropractic

By William C. Meeker, DC, MPH, FICC, Vice President for Research, Palmer Chiropractic University System

                For the sixth straight year in a row, the Research Agenda Conference (RAC) successfully met its aims. Two hundred chiropractic scientists, faculty members, practitioners, administrators, and other health professionals attended the two-day event in Kansas City, Missouri in July. At the meeting, it was announced that the Research Agenda Conference for 2002  (RACVII) will be held in collaboration with the annual meeting of the Association of Chiropractic Colleges in New Orleans, March 13-17. Administrative support will be provided, as before, from the Palmer Center for Chiropractic Research with funding from the Bureau of Health Professions of the Health Resources and Services Administration, and the Consortial Center for Chiropractic Research through a grant from the NIH, National Center for Complementary and Alternative Medicine.

            The Kansas City event proved to be an exciting informational and educational event. Keynote speaker, John Astin, PhD, from the University of Maryland, and a well-known researcher in the area of complementary and alternative medicine (CAM), led off with a very provocative charge to the chiropractic scientific community. “Enlarge your vision,” he said, “consider the possibility that chiropractic is not just a physically-based discipline, but that it may also relate to mind-body and even ‘subtle energy’ concepts.”

            William Johnson, PhD, a health economist specializing in workers compensation issues, and Pierre Cote, DC, MSc, PhD(cand), then tackled the thorny and controversial area of cost studies on chiropractic. It was their contention that definitive studies on the cost and cost-effectiveness of chiropractic care have not been done, and they described the major challenges. Dr. Johnson pulled no punches, indicating that the most recent data do not tend to demonstrate that chiropractic care is cheaper than medical care.

            In a reprise of last year’s panel discussion, a panel of distinguished leaders including James Dillard DC, MD, Arlan Fuhr, DC, George McClleland, DC, Jean Moss, DC, Gloria Niles, DC, Frank Nicchi, DC, Guy Riekeman, DC, and James Winterstein, DC, discussed the significance and impact of chiropractic research. Despite the contentions of many engaged in chiropractic research, these leaders assured the audience that what they were doing was having a beneficial effect. Comments and questions from the audience were very animated and exhibited the depth of feeling in the room on this topic.

            Workshops and breakout sessions were targeted to participants with specific needs. For example, Israel Goldberg, PhD, a former NIH director, discussed grant writing, while Kevin Lyons, PhD, editor of the Journal of Allied Health, focused on planning for new researchers. Other individual sessions included those on critical appraisal of the scientific literature with Anthony Rosner, PhD, Al Adams, DC, and Daniel Redwood, DC; the safety of chiropractic care with Marion McGregor, DC, MSc; ethical conduct in human research with Ian Coulter, PhD; an introduction to qualitative research methods and their application to chiropractic with Mary Koithan, RN, PhD, an anthropologist at the University of Arizona; how to report the results of a clinical trial with Cyndy Long, PhD, a statistician at the Palmer Center for Chiropractic Research; and writing for peer-reviewed journals with Dana Lawrence, DC, and Claire Johnson, DC, both editors of chiropractic journals. Jack Barnette, PhD, Associate Dean at the University of Iowa, delivered a post-conference workshop on biostatistics.

            Four state-of-the-art sessions dealt with specific areas of exciting chiropractic research: neurological approaches to researching the subluxation and adjustment; bioengineering approaches to the same; approaches to researching chiropractic techniques; and issues in assessing outcomes of chiropractic care. In each case, panelists presented their latest research and attempted to synthesize the progress and challenges in their area of expertise. In the eyes of many attendees, this was the most interesting part of the program.

            With Scott Haldeman, DC, PhD, as the facilitator, Joel Pickar, DC, PhD, Geoffrey Bove, DC, PhD, Donald Dishman, DC, MSc, and Brian Budgell, DC, PhD(cand) explained their work on joint and muscle receptors, nerve root function, somato-somatic reflexes, and autonomic and central CNS functioning. Clearly, the profession has made significant progress in laying the groundwork for understanding the neurological processes behind the subluxation and adjustment. We now have a cadre of chiropractors with additional training in neuroscience. Their work, while esoteric in the extreme in some cases, will allow us to make significant scientific breakthroughs.

            The same goes for the bioengineering approach. With Greg Kawchuk, DC, PhD, as facilitator, Partap Khalsa, DC, PhD, Ram Gudavalli, PhD, and John Triano, DC, PhD, presented their work on imaging techniques, altered segmental motion and facet joint strains, and measuring loads from flexion-distraction and HVLA adjustive maneuvers.

            One the most challenging areas of chiropractic research is chiropractic technique, particularly technique assessment and diagnostic procedures. Panelists Mitch Haas, DC, Edward Owens, DC, MS, Robert Leach, DC, and Jerry Grod, DC, tackled this all-important area. While perhaps controversial, the observation was made that even though over 50 randomized trials appear to clinically validate spinal manipulation and adjustment, the same cannot be said for the most common chiropractic evaluation methods. There is a real need to perform studies on the validity and reliability of technique procedures.

            Clinical scientists Cheryl Hawk, DC, PhD, Bart Green, DC, Nils Nilsson, DC, MD, and Eric Hurwitz, DC, PhD, presented their work and interpretations of the varied results that we seem to obtain in clinical trials. There was a growing consensus that many clinical trials are premature, and that a number of important questions should be answered before definitive trials should be undertaken. These include defining the dose and duration of chiropractic interventions, deciding on the proper mix of relevant outcome measures, and dealing with complex placebo and “sham” issues. The panelists agreed that there is still a large role for descriptive and observational studies to refine protocols for eventual experimental studies.

            A plenary session panel addressed the question of optimum adjustment and case management strategies. John Triano, DC, PhD, Robert Cooperstein, DC, Stephan Troyanovich, DC, and Jacqueline Bougie, MS, DC, gave the audience more questions than answers. The last session was a panel of chiropractic research directors. Facilitated by Dr. Meeker,  Howard Vernon, DC, Greg Plaugher, DC, Ronald Bulbulian, PhD, Dennis Nosco, PhD, and Betsy Singh, PhD, reported on the state of their programs, their success, and their challenges in developing research capacity in chiropractic institutions. Ian Coulter, PhD, gave the closing address, admonishing the audience to not give up, keep the long view in mind, and realize that the contributions of chiropractic science are extremely important to the profession and health care in general.

            RACVII and the ACC meeting for 2002 will be combined and held in New Orleans, March 13-17. The program and registration materials will be available via the Internet shortly. Information, as it develops, will be updated on the Consortial Center for Chiropractic Research website: www.c3r.org and on the Association of Chiropractic Colleges website: www.chiropractic.freeservers.com. This will be one of the most exciting scientific events in chiropractic. Make plans to attend as soon as possible.

            Dr. Meeker is Vice-President for Research for the Palmer Chiropractic University System, Director of the Palmer Center for Chiropractic Research, and Principal Investigator for the Consortial Center for Chiropractic Research, the first research center on chiropractic established by the NIH, National Center for Complementary and Alternative Medicine (NCCAM). Dr. Meeker is a member of the Advisory Council of NCCAM, and also serves on the Governing Council of the American Public Health Association. He is the Editor of the Journal of the Neuromusculoskeletal System.]