In my opinion, one of the reasons for the superior breed of DCs turned out by the CMCC is the influence that the CCS has exerted on the profession in Canada and on its oldest college. There are other explanations, to be sure, not the least of which has been the relatively luxury that CMCC has enjoyed of being able to turn applicants away, and thereby to choose the cream of the applicant pool for its student body. But the influence of CCS fellows, folks like David Cassidy, Silvano Mior and Howard Vernon (to name but a very few), has served to raise the level of dialogue among Canadian DCs on issues in science, technique and philosophy. The superior quality of chiropractic in Canada is no accident -- it was planned.
At about the same time that the CCS was getting underway, the US Office of Education mandated research in schools accredited by the newly recognized Council on Chiropractic Education (Schierholz, 1986, p. 45). The American Chiropractic Association's Foundation for Chiropractic Education and Research (FCER) began introducing new programs. Flushed with the success of its supporting role in helping to improve the quality of chiropractic education such that federal recognition of the colleges could be achieved, the FCER elected to make funds available to support graduate training of a few chiropractors. Among the early recipients of these training grants were such future high-yield scholars as Reed Phillips and John Triano. These FCER programs were gradually expanded in the 1980s and continue today to turn out a small number of chiropractor-scholars. Although a different path than the Canadian strategy, a somewhat similar (albeit more dilute) influence has been exerted on chiropractic in the US, and today a small degree of sustained scholarship is visible (as evidence in our best journals and in the periodicals of related disciplines).
I am unaware of any comparable effort on the part of the International Chiropractors Association (ICA) to train DCs as scholars and scientists. This is truly a pity, because if someone could find a way to harness the passion that many ICA doctors feel for chiropractic, harness it within the rigors of the scientific attitude and the scientific methods, a rich yield in clinical data and chiropractic scholarship might result. Alas, it was not to be, and the ICA continues to be dominated by true-believers who cannot or will not lower their guard long enough to find out which of various clinical theories and techniques may hold water and which not. However, the ICA deserves credit for its early support of University of Colorado scientist Chung Ha Suh, PhD, whose 1970s campaign for federal support of chiropractic research (directed first at the National Institutes of Health and then at the US Congress) led to the landmark 1975 HEW-sponsored conference on spinal manipulation. This conference is seen by some (e.g., Gitelman, 1984; Keating, 1992) as the birth of the modern era in chiropractic scholarship.
We have reason to pause and reflect and smile and say to ourselves, "Yes, there was practically no chiropractic scholarship back in the early 1970s, and now, as we approach the profession's centennial, there is a little bit." We have no reason for complacency, however. Our schools, for the most part, continue as poverty-stricken, tuition-driven, free-standing (i.e., isolated), shoe-string operations. Our faculty have little time outside their exceptionally heavy teaching loads to engage in the forms of scholarship that produce new knowledge or to critique existing theories and data. There is very little opportunity for faculty to interact with other scholars within the profession or in the wider health science community. Very few of our schools have a sufficient nucleus of faculty-scholars to enable self-propagation of the species chiro-scientist, and many of our schools have no interest in doing so. One president of a CCE-accredited college recently suggested "To hell with the scientists... they haven't even proven that the bumble bee can fly." These deficiencies are also reflected in the current state of the literature.
There are now several dozen controlled trials of the analgesic effects of manual methods (including spinal adjustment) for low back pain patients, and a smattering of controlled trials of manipulative methods for other health problems. Chiropractors have enjoyed some of the best press the profession has ever received because of a few of these trials and related critical reviews (e.g., Meade et al., 1990; Shekelle, 1991 a&b). However, a minority of these reports have been conducted by chiropractors, and in some cases the work has been conducted despite rather than because of the faculty member's host institution. For the most part, the college leaders, like the professional association politicians, have little interest in scholarly activity. It's simply not part of their experience, and they are unable to provide leadership in an area they know so little about.
The ACA, the ICA, and the colleges themselves could be making greatly increased contributions to specific research projects. They could be funding programs to develop greater research skills among chiropractic students. They could make grants to relieve teaching loads and to provide unassigned time for research to college faculty. They could provide attractive employment opportunities and debt-relief for young chiropractors who would like to develop careers in chiropractic scholarship and science. They could develop journal clubs to enable and encourage field doctors to increase their sophistication in interpreting new information as it evolves. These organizations and institutions could police themselves so as to make scientifically unsubstantiated claims for chiropractic care socially inappropriate. The impediments to and at least partial solutions for developing scholarship in the profession have been discussed repeatedly in the chiropractic literature (e.g., CHPG, 1991; DeBoer, 1993, 1988; Hanft, 1991; Keating, 1992), but seem to have produced little more than a cure for insomnia among the leadership.
With all the uncertainties of health care reform looming before the profession, a naive observer might guess that chiropractors, recognizing the tremendous political value that hard data and critical analyses offer, would be busy re-tooling for major research campaigns. However, the demonstrated wisdom of the scholarly initiatives of 20 years ago has not caught the imaginations of the profession-at-large. Pigs might fly someday, but the American branch of this profession seems determined to avoid the commitment to significant scholarly growth that current circumstances demand. Most of our schools continue in a struggle-for-survival mode, and are committed to training "brand new, old fashioned" doctors (DeBoer, 1988). We like to use the label "science," but we are generally uninterested in doing the work to make chiropractic a substantive, scholarly discipline. Not even in our own self-interest.
Lest we lose sight of it, the first purpose of the science of chiropractic is to promote patients' welfare.
Gitelman R. The history of chiropractic research and the challenge of today. Journal of the Australian Chiropractors' Association 1984; 144(4):142-6.
CHPG/Corporate Health Policy Group. An Evaluation of Federal Funding Policies and Programs and their Relationship to the Chiropractic Profession. 1991, Foundation for Chiropractic Education & Research, Arlington, Virginia.
DeBoer KF. Notes from the (chiropractic college's) underground. Journal of Manipulative & Physiological Therapeutics 1983 (Sept); 6(3):147-50.
DeBoer KF. Eine Kleine Nacht Musing. American Journal of Chiropractic Medicine 1988 (March); 1(1):41-3.
Hanft R. Presentation at the Foundation for Chiropractic Education & Research's International Conference on Spinal Manipulation, April 12, 1991, Arlington, Virginia.
Keating JC. Toward A Philosophy of the Science of Chiropractic: A Primer for Clinicians. Stockton, California: Stockton Foundation for Chiropractic Research, 1992.
Meade TW, Dyer S, Browne W, Townsend J, Frank AO. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. British Medical Journal 1990 (June); 300:1431-7.
Schierholz AM. The Foundation for Chiropractic Education & Research: a history. Unpublished (January 1986), Foundation for Chiropractic Education & Research, Arlington, Virginia.
Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Phillips RB, Brook RH. The Appropriateness of Spinal Manipulation for Low-back Pain: Project Overview and Literature Review. 1991A, RAND Corporation, Santa Monica, California (Document #R-4025/1-CCR/FCER).
Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Park RE, Phillips RB, Brook RH. The Appropriateness of Spinal Manipulation for Low-back Pain: Indications and Ratings by a Multidisciplinary Expert Panel. 1991b, RAND Corporation, Santa Monica, California (Document #R-4025/2-CCR/FCER).
Joseph Keating Jr., PhD
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