The NIH is not only a MD dominated organization, but it is also very "laboratory oriented." As one might anticipate, high quality research proposals from the chiropractic researchers were not given very high regard many times for purely philosophical reasons.
But in December of 1989, the United States Congress created the Agency for Health Care Policy and Research (AHCPR) within the Department of Health and Human Services (HHS). The activities of the AHCPR will be:
- Fund and develop scientific research.
- Evaluate new ways of organizing, financing, and directing health care services.
- Assess technologies being considered for reimbursement by federally funded programs.
- Facilitate the development of practice guidelines and measurements of quality care.
- Promote the utilization of health care services research findings.
It does not require very much imagination to appreciate just how this agency will drastically change the environment within which the chiropractic profession exists. Were our profession to fail to respond and excel in any one of these areas, the results could be devastating.
But there are a few rays of hope. The AHCPR is not like the NIH. The AHCPR is a primary care/clinical research funding organization. This fact alone not only gives chiropractic a chance to be included, it does so on the very level we have worked to maintain for so many years: primary care.
All funding for primary care research will come from the AHCPR. If the chiropractic profession is able establish itself with this organization, and be recognized and funded as a primary care profession on a federal level, it would open many research and political doors across the nation and around the world.
The fact that the AHCPR is barely one year old is another advantage; there are currently few firm barriers against chiropractic. The fact that the agency has a primary care focus, creates an alliance of chiropractic, psychology, psychiatry, and all of the other health care specialties that have been virtually ignored by the NIH.
But this is a research organization. You can't buy your way in. You can't scream and yell your way in. And you can't afford to just ignore them. You have to earn your way in.
The AHCPR held its Second Annual Primary Care Research Conference in San Diego, California recently on January 13 - 15, 1991. Fortunately, the chiropractic profession was well represented. Reed Phillips, D.C., Ph.D., a researcher and acting president of the Los Angeles College of Chiropractic, submitted a "poster" which was accepted for presentation at the conference.
A poster is a presentation in which all of the data, graphs and charts for a research presentation are placed on a three foot by eight foot "poster" which is displayed in a special area. At this conference there were over 500 individuals, most of whom were attempting to represent their area of health care specialty.
In the hierarchy of scientific presentations, there are first the speaker and then the posters. At the AHCPR's conference, there were only a few speakers and only twenty-five posters accepted. Chiropractic was presented on one of those twenty-five posters.
The title of Dr. Phillip's presentation was "Cost Per Case Comparison of Back Injury Claims of Chiropractic Vs. Medical Management for Diagnostically Similar Conditions." During the time that the posters were reviewed, Dr. Phillips fielded many questions and was able to enlightened many about the benefits of chiropractic care.
The comparison that Dr. Phillips presented was a study of costs from the Utah Workers' Compensation program. The study was co-authored by Kelly B. Jarvis, D.C. and Elliot Morris, J.D., the director of Workers' Compensation in Utah. Two chiropractic researchers from Northwestern College of Chiropractic; William Jose, Ph.D. and Kassen Kassak, M.P.H. were also at the conference. In addition, the study has been accepted for publication by the Journal of Occupational Medicine.
A number of the participants who were able to see the cost factors associated with chiropractic care made inquiries as to how they could receive further information on chiropractic in the managed health care setting. When asked about the significance of a chiropractic presentation at the conference, Dr. Phillips remarked, "It was a significant honor and a very important step forward in our attempts to gain recognition in federal funding programs."
The deputy director of the AHCPR, Paul Nutting, M.D., gave Dr. Phillips the distinct impression that he was open to the chiropractic profession joining the AHCPR process. The Foundation for Chiropractic and Research (FCER) will feature the director of the AHCPR, J. Jarrett Clinton, M.D., M.P.H., as their featured speaker at this year's International Conference on Spinal Manipulation. (The conference takes place on April 12-13; please call (703) 276-7445 for more information.) It will be very interesting to see what Dr. Clinton's impression of chiropractic is after he attends the ICSM.
Unfortunately, this is only a beginning. Dr. Phillips made quite clear the fact that the chiropractic profession needed to make contacts, present research, serve on committees, and generally make our presence felt if we hope to be included with the AHCPR in the future.