In the hours and days following the 136th running of the Belmont Stakes on June 5, I was informed that the neighborhood around the racetrack in Elmont, New York, was not a pleasant place to be. The prohibitive favorite, Smarty Jones, who had departed the starting gate at 2-5 odds, had just been whipped by a 15-1 nag - a relative long shot in the racing business. Thus, we're reminded of that classic axiom of railbirds and other racing aficionados: There is no such phenomenon as a sure thing.
And so it is with research, chiropractic or otherwise. A quotation I read at a recently dedicated art museum in Vienna sums it up perfectly: "Proof of the existence of information does, in fact, not exist in actuality, but is based on probability."1
This is by no means to discredit or discount the value of research. Indeed, I have recently outlined, in some detail, the accomplishments and importance of research as it pertains to the practitioner.2 But as I have done so many times before, I need to comment upon how research needs to be monitored and interpreted judiciously to avoid the plight of Rick, who, in the movie "Casablanca" informed the authorities as to why he had incredulously chosen to come take the waters at a locale in the middle of the desert: "I was misinformed."
A recent clinical investigation that gives us pause recently appeared in JAMA, featuring an author (Gotzsche) who has long been a compelling critic of the foibles of clinical research undermining its validity.3,4 This most provocative study compared what is published in clinical studies with what the authors originally submitted for ethical approval, so that the research could be carried out in the first place. The disparities between the original designs and what appeared in the end could only be described as unnerving:
If clinical research is to be conducted properly, without these hobgoblins, where does FCER fit in? Simply through its ongoing sponsorship of thoroughly peer-reviewed research, an example of which (tension headache study) was rated among the highest in quality by four independently conducted published systematic literature reviews.7-10 Also through its vigorous interpretations and rebuttals of spurious conclusions found in the scientific literature over the past decade,11-17 more recently pertaining to cost-effectiveness misinterpretations in the literature,18,19 FCER has taken a highly proactive position in enabling the chiropractic physician to interpret and articulate the current literature to both patients and prospective payors alike. Such is to simply state that FCER remains a primary source of reference and interpretive material pertaining to chiropractic research.
References
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
