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Chiropractic and Alternative/Complementary Medicine: What is Going On?By William Meeker, DC, MPH, FICC A few years ago the federal legislature established the Office of Alternative Medicine (OAM) within the National Institutes of Health. There was a great deal of public rhetoric about how it was finally coming to pass that so-called "unconventional" health practices were going to get a fair shake in research. Although many chiropractors and chiropractic supporters were happy with this development, the implications of a new Office of Alternative Medicine were not necessarily a good thing. For starters, the budget was only $2 million, hardly a drop in the ocean of money spent every year by the government on biomedical research. This paltry amount is hardly equal to the task of scientific evaluation and is an indication of how weak the political support was for such an effort. Secondly, the alternative medicine community is much, much broader than chiropractic, and much of it has strong support from within the medical establishment itself. For example, the strongest proponents of acupuncture happen to be medical physicians qualified in acupuncture. They use it mainly for pain control, and it is used in academic medical centers, the same centers that already have a research track record and already enjoy federal research money.Thirdly, and perhaps most importantly, there are good reasons why the chiropractic profession should distance itself from the many fringe elements in so-called alternative medicine. It has been no secret that politically speaking, the new Office of Alternative Medicine was not popular with the rest of the National Institutes of Health. Most administrators there would like to see it go away. Chiropractic, on the other hand, has been able to win some grudging respect in the government due to the research on manipulation published in the last few years, and due also to the expert and untiring labor of our professional lobbyists in Washington. The advent of chiropractic research funding through the Health Resources and Services Administration is an indication that chiropractic is being seen in a different and more "established" light than all the other "alternatives" lumped with the OAM. As it turned out, no chiropractic research was initially funded by the OAM, even though a number of proposals were submitted. Most of the chiropractic research community wrote off the OAM as a source of support because they saw it as too political and too difficult to obtain what little money that existed. Things may be changing now however. Several recent events may turn out in hindsight to have been significant in the quest to give many non-medical procedures a fair scientific test. The first was a conference sponsored by Harvard Medical School, "Alternative Medicine: Implications for Clinical Practice." The meeting was held at the beginning of April and included presentations on chiropractic by Dr. Alan Adams and Dr. Paul Shekelle. Dr. Adams described the chiropractic profession in general terms; Dr. Shekelle focused on the RAND reviews of spinal manipulation. About 450 sympathetic attendees, mostly medical physicians, heard about recent research on such things as acupuncture, homeopathy, naturopathy, and "mind-body" approaches. There were 15-20 to twenty chiropractors in the audience. Among the interesting factoids was that 27 of the nation's medical schools offer courses in alternative medicine. The second event was a meeting just one week later at Stanford University, "Alternative Medicine: Assessing the Value of Unconventional Therapies in America's Health." The program at Stanford was remarkably similar to the one at Harvard and even featured some of the same speakers. Again, chiropractic played a prominent role, this time in two separate breakout sessions. Chiropractors George McClelland, Gerard Clum and Alan Sherr made excellent presentations. This author had the honor of debating Dr. Wallace Sampson of National Council Against Health Care Fraud, Inc., fame in a panel on regulatory perspectives. The third event came another week later with the convening of the 2nd OAM Conference on Methodology. This event was preceded by a group brought together to form a special interest "alternative/complementary" medicine "field" within an international effort called the Cochrane Collaboration. The Cochrane Collaboration, which has a rich history of its own, is dedicated to collecting and publishing systematic reviews of randomized clinical trials. Chiropractic researcher Dr. Maria Hondras was appointed to the steering committee. The OAM Methodology meeting itself was an impressive gathering of many world-famous scientists and practitioners interested in "alternative/complementary" medicine practices. They spent days hammering out principles of research which will be published by the OAM for use by alternative researchers. Dr. Wayne Jonas, the newly appointed head of the OAM is to be congratulated for the quality of the work that was obtained. What can be made of these events? It is difficult to say. The funding for the Office of Alternative Medicine is in doubt, like many federal programs right now, but some interesting observations can be offered based on what was heard at these meetings.
In summary, the extent to which chiropractic should align itself with the so-called "alternative/complementary" medicine community is an open question. The answer probably depends on which goals could reasonably be pursued with the least risk to our growing good reputation. It at least is a question that deserves articulate and thoughtful debate. William Meeker, DC, MPH Click here for previous articles by William Meeker, DC, MPH, FICC.
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